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

Impetigo

• 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

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

Nonbullous Impetigo

• Most common form of impetigo
• Also known as crusted impetigo or impetigo contagiosa
• Most common in children 2-5 years of age
• Complication: Risk of glomerulonephritis especially in children aged 2-6 years

Bullous Impetigo

• Newborns and 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 with diabetes mellitus (DM) 
• May be a de novo infection or a superinfection

Nonbullous Impetigo

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

Bullous Impetigo

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

Ecthyma

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

Nonbullous Impetigo

• Initially presents with macules or papules that quickly become small vesicles
  • Vesicles quickly pustulate and rupture leaving an erosion or clusters of erosion
  • Purulent discharge dries and 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 and mouth) and extremities
• Carrier state: 4% of adults may be asymptomatic carrier

Bullous Impetigo

• 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 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, and typically found on the face, buttocks, perineum and extremities, the trunk more frequently affected; in neonates, around the diaper area

Ecthyma

• 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 usually found on the buttocks, legs and feet
  

Nonbullous Impetigo

• 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 and malnutrition, heat and high humidity