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