impetigo%20-and-%20ecthyma%20(pediatric)
IMPETIGO & ECTHYMA (PEDIATRIC)
Impetigo is a very contagious, superficial, bacterial skin infection that easily spreads among people in close contact.
Most cases resolve spontaneously without scarring in approximately 14 days without treatment.
Ecthyma is deeply ulcerated form of impetigo that extends to the dermis. The ulcers are "punched-out" with yellow crust and elevated violaceous margins.
It may be an infection de novo or a superinfection.

Definition

Impetigo

  • A very contagious, superficial, bacterial skin infection that easily spreads among people in close contact
  • Most cases resolve spontaneously w/o scarring in approximately 14 days w/o treatment
  • Complication: Risk of glomerulonephritis especially in patients aged 2-6 years old

Ecthyma

  • Deeply ulcerated form of impetigo that extends to the dermis
    • “Punched-out” ulcers w/ yellow crust & elevated violaceous margins
  • May be an infection de novo or a superinfection

Signs and Symptoms

Clinical Presentation

Nonbullous Impetigo

  • Most common form of impetigo; also known as crusted impetigo or impetigo contagiosa
  • Most commonly occurs in children 2-5 years of age
  • Initially presents w/ macules or papules that quickly become small vesicles that may have narrow inflammatory rings
    • The vesicles quickly pustulate & rupture easily over 4-6 days leaving an erosion or clusters of erosion
    • Purulent discharge dries & forms “honey-colored” crusts
  • Occasionally, patients may suffer pruritus or pain & usually have local adenopathy
    • About 50% of patients have leucocytosis
  • Lesions are typically found on exposed areas of the face (especially around the nose & mouth) & extremities

Bullous Impetigo

  • Typically occurs in infants, newborns & young children
  • Lesions (0.5-3 cm in diameter) typically develop on intact skin & begin as vesicles that turn into flaccid bullae that contain yellow serous fluid
  • Bullae rupture easily & a moist red-surfaced erosion appears surrounded by a “collarette” of scale, which then forms a thin varnish-like light brown crust
  • Generally, there is no surrounding erythema but may have regional lymphadenopathy, pain or systemic symptoms
  • Lesions are often multiple, rapidly spread, & are typically found on the face, buttocks, trunk, perineum & extremities; in neonates, around the diaper area

Ecthyma

  • Typically occurs in children 6 months-18 years, & in immunocompromised patients
  • Lesions initially appear as pustules & vesicles that become ulcerated
    • Ulceration is frequently covered by adherent crusts
    • Associated w/ pain & lymphadenopathy; heals w/ scarring
  • Lesions are typically found on the legs

Etiology

Nonbullous Impetigo

  • Staphylococcus aureus & group A beta-hemolytic streptococci (GABHS)

Bullous Impetigo

  • Always caused by coagulase-positive S aureus

Ecthyma

  • GABHS; S aureus is typically cultured from the lesions but is usually a secondary pathogen

Risk Factors

Nonbullous Impetigo

  • Poor hygiene, warm climate, interruption of the skin by lesions in the affected area, eg insect bites, wounds, viral infections (chicken pox, herpes simplex), scabies or burns

Ecthyma

  • Insect bites, scabies, pediculosis, poor hygiene, malnutrition, heat & high humidity
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