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

Impetigo%20-and-%20ecthyma Signs and Symptoms

Introduction

Impetigo (Nonbullous)

  • Most common form of impetigo
  • Also known as crusted impetigo or impetigo contagiosa
  • Most common in children 2-5 years of age

Impetigo (Bullous)

  • Newborns & younger children are commonly affected

Ecthyma

  • Typically occurs in children 6 months-18 years, in the elderly, immunocompromised [eg neutropenia, human immunodeficiency virus (HIV)], or patients w/ diabetes mellitus (DM) 

Definition

Impetigo

  • A very contagious, superficial, bacterial skin infection that easily spreads among people in close contact
  • Most cases occur in children & resolve spontaneously w/o scarring in approximately 14 days

Ecthyma

  • Deeply ulcerated form of impetigo that extends to the dermis
    • “Punched-out” ulcers w/ yellow crust & elevated violaceous margins

Etiology

Impetigo (Nonbullous)

  • S aureus & group A beta-hemolytic streptococci (GABS)

Imptetigo (Bullous)

  • Always caused by coagulase-positiveS aureus
    • A localized form of staphylococcal scalded skin syndrome

Ecthyma

  • Group A beta-hemolytic streptococci (Streptococcus pyogenes); S aureus is typically cultured from the lesions but is usually a secondary pathogen

Signs and Symptoms

Impetigo (Nonbullous)

  • Initially presents w/ macules or papules that quickly become small vesicles
    • Vesicles quickly pustulate & rupture leaving an erosion or clusters of erosion
    • Purulent discharge dries & forms honey-colored crusts
  • Usually asymptomatic though local adenopathy is common; pruritus or pain may occur occasionally
  • Lesions are typically found on exposed areas of the skin on the face (especially around the nose & mouth) & extremities
  • Carrier state: 4% of adults may be asymptomatic carrier

Impetigo (Bullous)

  • Newborns & younger children are commonly affected
  • 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 thin rim 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, & typically found on the face, buttocks, perineum & extremities,the trunk more frequently affected; in neonates, around the diaper area

Ecthyma

  • 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 usually found on the legs

Risk Factors

Impetigo (Nonbullous)

  • Poor hygiene; warm climate; crowding; preceding skin breaks in the affected area from insect bites, wounds, viral infections (chicken pox, herpes simplex), scabies or burns; prior skin disease eg eczema, atopic dermatitis

Ecthyma

  • Insect bites, scabies, pediculosis, poor hygiene & malnutrition, heat & high humidity
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Infectious Diseases - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 03 Sep 2018

The rate of syphilis reactivity appears to be higher in individuals with dementia compared with those without the condition, a Singapore study has found.

12 Jun 2019
Urogenital infections remain a major reason for women to visit their family physician and their subsequent referral to obstetrics and gynaecology or urology specialists. The association between abnormal vaginal microbiota and an increased risk of contracting sexually transmitted diseases (STDs), as well as an increased rate of preterm labour, indicates the need to better understand and manage urogenital health in women. Probiotics are “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host”. As such, there is a sound rationale for using probiotics to maintain female vaginal and bladder health.
Jairia Dela Cruz, 16 Apr 2020
The odds of women passing coronavirus disease 2019 (COVID-19) to their sexual partners appear to be low, with two studies showing no evidence of the disease-causing SARS-CoV-2 virus existing in the vaginal fluids of infected patients.
Pank Jit Sin, 29 May 2020
With the world literally being put on hold by the SARS-CoV-2 virus, stakeholders around the world are rushing to develop a vaccine that will put back some semblance of normalcy into everyone’s lives.