Journal Reading :

Bullous Impetigo Rapid Diagnostic and Therapeutic

Quiz: A Model for Assessing Basic Dermatology
Knowledge of Primary Care Providers

Presenter :
Zihan Aulia Nugraha. S,Ked
Mentor :
Dr. Arif Effendi. Sp.KK
 BACKGROUND
• Bullous impetigo (BI) is a common dermatologic
condition, particularly in children, yet confusion
regarding its diagnosis and treatment persists. This
study measured pediatricians’ ability to diagnose and
appropriately treat BI and explored factors that might
influence pediatricians’ accuracy in managing BI
• The purpose of our study was to examine pediatricians’
ability to diagnose and appropriately treat BI and to
explore factors that might influence pediatricians’
accuracy in managing BI
 METHODS
• We recruited 64 physicians (25 faculty, 39
house staff) through the Department of
Pediatrics at the Johns Hopkins Hospital, the
Harriet Lane Clinic, and Bayview Medical
Center in Baltimore, Maryland, from January
to April 2015
• and asked participants to provide their most
likely diagnosis for each in free-text format
 Bullous Impetigo
Figure 1. A 6-year-old girl with an itchy skin rash for 5 days.
 Bullous Impetigo
Figure 2. A 12-year-old boy with minimally itchy rash for 5 days.
 RESULTS
• Diagnosis
– Overall, pediatricians correctly diagnosed bullous
impetigo 31.9% (102/320) of the time (residents
30.8% [60/195]; faculty 33.6% [42/125]).
– 86% (55/64) of pediatricians correctly diagnosed
the case depicting a 12 year old boy
Diagnosis of Unknown Cases According to the
Age of the Child (Years)
Bullous 15 (7) 10 (5) 16 (6) 55 (19)
impetigo or
impetigo
Pityriasis rosea 1 1 (1) 0 0
Tinea corporis 0 8 (5) 0 0
Eczema 0 2 10 (5) 0
Cellulitis 12 (2) 0 3 (2) 0
Contact 1 (1) 11 0 0
Psoriasis 0 3 (1) 2 (2) 0
Tinea 1 1 (1) 1 0
Herpes simplex 2 (1) 1 (1) 0 3 (3)
virus
Staph infection 1 (1) 1 (1) 1 2 (2)
Atopic dermatitis 0 2 (1) 3 (1) 0
Molluscum, 0 5 (2) 0 0
molluscum
contagiosum
Superinfected eczema 0 0 5 0
Coxsackie 1 0 1 1
Spider or insect bite 4 (3) 0 0 0
• Treatment of localized
– mupirocin (64.0% [41/64]) first-line
– mupirocin (23.4% [15/64]) second-line
 Treatment of Localized BI

Treatment First line Second line

Mupirocin 41 (18) 15 (5)
Bacitracin 14 (2) 6 (2)
Clindamycin (topical) 1 (1) 3 (2)
Topical steroids 2 1
Nothing 2 (1) 0
Neosporin 0 2 (2)

Triple antibiotic ointment 0 2

Triamcinolone 1 1
• Treatment of widespread BI
– Cephalexine 35,9 % first-line
– Clindamycin Oral 25,0 % second-line
Treatment of widespread BI
Treatment First Line Second Line

Clindamycin (oral) 16 (6) 25 (10)

Cephalexin 23(10) 4 (2)

Amoxicillin 9 (2) 5 (1)

Trimetrhoprim 3 (2) 8 (3)

sulfamethoxazole
Amoxicillin– 4 (3) 2 (1)
clavulanate
Prednisone 2 0
Penicillin 2 0
Vancomycin 0 2 (2)
 DISCUSSION
• This study sought to shed light on
pediatricians’ fluency with BI, a common
dermatologic condition in children, the
pathophysiology and clinical presentation
• Our results reveal a need for sharpening of
diagnostic and management acumen
• Although older, more experienced pediatrics
faculty performed better on the diagnostic
section
 DISCUSSION
• One way to achieve the desired improvement in BI
management would be to encourage wound culture,
particularly given regional variations in antibiotic
sensitivity
• A second way to improve diagnosis and treatment is
through basic dermatology education
• It is our hope that this study, and similar studies in the
future, can help illuminate these subtleties of diagnosis
and management of BI and other common conditions
and refine targeting of future educational efforts.
 LIMITATIONS
• No general practitioners in the community
were surveyed in this study; participants were
selected exclusively from Johns Hopkins
academic medical institutions in Baltimore,
Maryland
 CONCLUSION
• Improved pediatrician proficiency in the
diagnosis and treatment of BI could have
profound effects on the promptness of
appropriate patient care.
• Physician age and experience appear to have
a limited effect on BI diagnosis accuracy and
management. Therefore, educational efforts
must be directed at trainees as well as their
instructors.
THANK YOU // HATUR NUHUN
@ZihanNugraha