Impétigo

The Impétigo is a surface cutaneous infection bacterial, due to a Streptocoque and/or a Staphylocoque. It is a pathology autoinoculable and not immunizing. Contrary to the popular beliefs, the impétigo does not emerge from a lack of hygiene.

It is contagious with small family epidemics or communities which justify the school ousting. In the adult one impétigo almost always testifies to preexistent cutaneous lesions, in particular of a ectoparasitose, because the bacteria are introduced into the skin through the various lesions. One can thus see appearing the impétigo with the favor of various skin diseases (like the Eczéma, the Gale or a Pédiculose), or simply scratches and the insect bites.

Diagnosis

The usual shape of the child

The elementary lesions cause an eruption of Vésicule S or small translucent bubble S which, at the end of a few hours, is disturbed and becomes Pustule S which burst by releasing their contents which form a yellowish crust while being desiccated. These crusts are known as “meliceric” i.e. honey color.

The impétigo appears especially on the level of the face, in particular on the circumference of the nose and the mouth because of the important presence of the bacteria on this level. It can however appear on other parts of the body like the scalp, the arms and the legs because of the manual bearing.

In theory, once disappeared, the lesions do not leave any scar.

Bulleux Impétigo

It is about the characteristic form observed at the new born one. It has a bacterial origin (staphilococcus). The bubbles can be of big size and be surrounded by a diffuse erythema. The lesions end in crusts which dry and fall quickly.

Complications

The syndrome of épidermolyse staphylococcic

It is characterized by an separation of the skin located primarily around an infectious hearth and is associated with a destruction of the skin with a detachment of this one in the form of scraps. It is accompanied by an important deterioration by the general state with fever and a dehydration.

Ecthyma

It is about a form digging of impétigo. It is generally located on the level of the lower extremities. This form is most generally found at fragile subjects like the alcoholics, the diabetics, immunodéprimés, the subjects dénutris and with precarious hygiene. Ecthyma begins like a banal impétigo in the form from a bubble or a pustule. The crust which replaces the pustule is very broad, round, noirâtre, measuring from 10 to 20 mms in diameter. Ecthyma can constitute the starting point of a true ulcer of leg and take an extensive form.

Evolution

It is quickly favorable. Very seldom a impétigo can be the main door of a severe general infection to streptocoque or staphilococcus.

Treatment

Local treatment

A local treatment can be enough in the forms far from wide; it consists in the softening of the crusts, by pulverizing water of Dalibour above and while applying:
  • disinfectants (chlorhexidine…)
  • antibiotic topics (fusidic acid…).

Antibiotic treatment

It is generally prescribed. A treatment by general way can be necessary if the lesions are extended too much or if the certainty which the local care will be correctly applied is not absolute. But in the event of wide lesions not very (<2% of body surface) one uses, after having if need be softened the crusts with petroleum jello, of local antibiotics such as:
  • Mupirocine (in pomade);
  • Fucidine (in cream);
  • retapamulin (in pomade) in the event of suspicion of infection by Staphylococcus aureus or Streptococcus pyogenes

If not, the choice of antibiotic by general way relates to the following families:

  • Macrolide ;
  • Fusidic acid in compressed or liquid;
  • Penicillin;
  • Synergistine like the pristinamycine.

Complimentary measures

  • school ousting of a few days;
  • treatment of the phratry;
  • taking away and treatment of the lodgings for all the family in the event of repetition.

References

  • Course of the French company of Dermatology
  • Photographs of impétigo

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