impetigo%20-and-%20ecthyma%20(pediatric)
IMPETIGO & ECTHYMA (PEDIATRIC)
Treatment Guideline Chart
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.

Impetigo%20-and-%20ecthyma%20(pediatric) Signs and Symptoms

Definition

Impetigo

  • 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
  • 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 with yellow crust and elevated violaceous margins
  • May be an infection de novo or a superinfection

Signs and Symptoms

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 with macules or papules that quickly become small vesicles that may have narrow inflammatory rings
    • The vesicles quickly pustulate and rupture easily over 4-6 days leaving an erosion or clusters of erosion
    • Purulent discharge dries and forms “honey-colored” crusts
  • Occasionally, patients may suffer pruritus or pain and usually have local adenopathy
    • About 50% of patients have leucocytosis
  • Lesions are typically found on exposed areas of the face (especially around the nose and mouth) and extremities

Bullous Impetigo

  • Typically occurs in infants, newborns and young children
  • Lesions (0.5-3 cm in diameter) typically develop on intact skin and begin as vesicles that turn into flaccid bullae that contain yellow serous fluid
  • Bullae rupture easily and 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, and are typically found on the face, buttocks, trunk, perineum and extremities; in neonates, around the diaper area

Ecthyma

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

Etiology

Nonbullous Impetigo

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

Bullous Impetigo

  • Always caused by coagulase-positive S aureus

Ecthyma

  • GABHS (Streptococcus pyogenes); 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, and high humidity
Editor's Recommendations
Special Reports