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

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

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

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

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