IMPETIGO,

ERYSIPELA
S,
CELLULITIS
RASAY, JOANA MIKEE D.
 IMPETIGO
CONAGIOSA
MPE T IG O C O NTAG IO SA
Aka NON-BULLOUS IMPETIGO

STREPTOCOCCA
STAPHYLOCOCAL COMBINED
L

DISCRETE, THIN-
PUSTULAR RUPTURE
WALLED VESICLES
MPE T IG O C O NTAG IO SA

FACE HAND NECK

EXTREMITIES SCALP
MPE T IG O C O NTAG IO SA
2mm
erythematous vesicles bullae
macules

THIN, STRAW-COLORED,
SEROPURULENT
DISCHARGE
MPE T IG O C O NTAG IO SA

Loosely Removed:
Collects
stratified smooth,
Exudate Thick, droplets
golden red,
dries friable of fresh
yellow moist
exudates
crust surface
MPE T IG O C O NTAG IO SA
Spread to other parts of the
body
• Fingers or towels
Spread peripherally: skin clears
centrally, large circles are
formed by fusion of spreading
lesion
• GYRATE PATTERNS

STREPTOCOCCAL-INDUCED
IMPETIGO
• Regional lymphadenopathy
MPE T IG O C O NTAG IO SA
50-70%: Staphylococcus aureus

Streptococcus pyogenes
• Early pathogen in development of impetigo
• Replaced by staphylococcu as the lesion matures

Group B streptococci
• Newborn impetigo

GROUP C AND G
• Rarely isolated
MPE T IG O C O NTAG IO SA
Most frequently In childhood
• All ages may be affected

Occurs in temperate zone

• summer
• Humid weather

IN CHILDREN:
Other
Dirty Day care
Pets children in
fingernails centers
schools

Crowded
housing
areas
MPE T IG O C O NTAG IO SA
IN ADULTS:

Self- inoculation
Infected
from nasal or
children
perineal carriage

COMPLICATIONS

Pediculosis capitis Scabies HSV

Other
exudative,
Insect bites Poison Ivy Eczema pustular, or
itching skin
disease
MPE T IG O C O NTAG IO SA
Group A beta-hemolytic streptococcal skin infection
• Followed by Acute glomerulonephritis

Nephritogenic streptococci
• IMPETIGO > UPPER RESPIRATORY TRACT INFECTION

TYPE 49, 55, 57, 60, M-TYPE 2

• NEPHRITIS

AGN + IMPETIGO (2%-5%)

• Most frequently in childhood
• Before age 6
• Prognosis: excellent in children, not as good in adults
• Early and appropriate treatment: will not reduce risk of AGN
MPE T IG O C O NTAG IO SA
IMPETIGO: Superficial, very weepy lesions covered with thick, bright-yellow
or orange crust with loose edges

RINGWORM
• Circinate patches

TINEA
• scaling patches with peripheral erythema

Toxicodendron dermatitis
• More crusted and pustular
• Invole the nostrils, corners of the moth and ears

Dermatitis: eye puffiness, linear lesions or itchiness

• Poison ivy or oak

Ecthyma : crusted ulcer, not erosions

MPE T IG O C O NTAG IO SA

Systemic antibiotic with topical therapy

• Semi-synthetic penicillin
• 1st generation cephalosporin

Given for 7 days

Soak off the crust frequently after which an antibacterial ointment
should be applied
Localized lesions (facial, present in healthy child)
• Topical therapy

Antibiotic ointment as prophylaxis

• Sites of trauma
• Prevent impetigo in high-risk children attending day care centers
MPE T IG O C O NTAG IO SA
Recurrent impetigo
• (+) culture
• Mupriocin ointment, BID applied in
the anterior nares
• Rifampicin 600 mg/day for 10 days
• Rifampicin 600 mg/day +
Dicloxacillin (MRSA)
• TMP-SMX (MRSA)
BU LLOU S
IMPETIGO
B U LLOU S IM PE T IG O

Occurs in newborn
• Highly contagious
• Threat in nurseries
• 4TH- 10TH days of life
B U LLOU S IM PE T IG O
Common early sites:

FACE HAND
B U LLOU S IM PE T IG O

Weakness, fever or subnormal temperature

Diarrhea
• Green stools

Bacteremia, pneumonia, meningitis

In adults:

axill
a
groi
ns
han
ds x
scal
p
 BULLOUS IMPETIGO

CIRCINAT
LARGE E WEEPY IMPETIGO
PEMPHIG
FRAGILE US RUPTURE OR CIRCINAT
BULLAE CRUSTED A
LESIONS
B U LLOU S IM PE T IG O

Children
• History of insect bite
• Phage type 71 or 55 coagulase-
positive S. aureus
• Group 2 Phage type
Early manifestation of HIV
infection
ERYSIPELAS
ERY S I PE LA S
Aka ST. ANTHONY’S FIRE, IGNIS SACER
Acute B-hemolytic group A streptococcal
infection
Streptococci group C or G

Streptococci Group B
• newborn
• abdnominal or perineal erysipelas in post partum women

Superficial dermal lymphatics

 ERYSIPELAS
local redness, heat,
swelling, raised indurated
boarder
ERY S I PE LA S
MALAISE for several hour

chills, high fever, headache, vomiting and

joint pains

PMN leukocytosis of >/=20,000 cells/mm3

ERYTHEMATOUS LESION without

associated systemic complaints
ERY S I PE LA S
Slight Intense
Transient Vesicle or
desquama inflammati
hyperemia Bullae
tion on
ERY S I PE LA S
Erythematous Peripheral
patch extension

Scarlet, hot to the touch, branny, swollen

Advancing edge of the patch

• raised, sharply demarcated
• Feels like a wall
Vesicles or bullae with seropurulent fluid
occur
• result in local gangrene
ERY S I PE LA S
Common early sites:

LEGS FACE
Begins in the cheek
Edema and bullous Near the nose
lesions Infront of the lobe of the ear
Spreads upward to the scalp
Hairline acting as a barrier
ERY S I PE LA S

COMPLICATIONS:

Necrotizi Abscess
Septicem Deep
ng formatio
ia cellulitis
fasciitis n
Especially in Obese and with Chronic alcohol abuse
ERY S I PE LA S
Predisposing factors:

Fissures in the
nares and Under the
Surgical wound Anus or penis
auditory earlobes
meatus

Between or
under the toes, Abrasions or Venous
Obesity
usually the scratches insufficiency
little toe

Chronic leg
Lymphedema
ulcers
ERY S I PE LA S
Differentials:

Contact
dermatitis Angioneurotic
(plants, drugs edema
or dyes)
ERY S I PE LA S
Differentials:

Fever, pain
and Itching -
tenderness SEVERE
- ABSENT
ERY S I PE LA S
Differentials:

Contact
dermatitis Angioneurotic
(plants, drugs edema
or dyes)

Butterfly
pattern on
the face
ERY S I PE LA S
Differentials:

Contact
dermatitis Angioneurotic
(plants, drugs edema
or dyes)

Lupus
erythematosu
s
ERY S I PE LA S
Differentials:

Contact
dermatitis Angioneurotic
(plants, drugs edema
or dyes)

Lupus
Ear
erythematosu
involvement
s
ERY S I PE LA S
Differentials:

Contact
dermatitis Angioneurotic
(plants, drugs edema
or dyes)

Lupus
Relapsing
erythematosu
polychondritis
s
ERY S I PE LA S
Systemic penicillin
• improvement occurs in 24-48 hours
• cutaneous lesion: several days

Vigorous treatment with antibiotic

• continued for 10 days

Local: ice bag, cold compress

Leg involvement
• hospitalization with IV antibiotics
ERY S I PE LA S

Elderly, immunocompromised, longer

duration of illness before presentation, with
leg ulcer
• longer hospitalization

Recurrent disease
• long-term antibiotic prophylaxis may be beneficial
CELLULITIS
C E L LU LIT IS
suppurative
inflammation of
subcutaneous tissue
follows discernible
wound

Tinea Pedis
• Most common portal of
entry in the leg
C E L LU LIT IS
Mild local erythema,
tenderness, malaise, chilly
sensation, sudden chill and
fever

Erythema rapidly becomes

intense and spreads

Infiltrated and pits on

pressure

Central: Nodular, surmounted

by a vesicle which ruptures
and discharges pus and
necrotic material
C E L LU LIT IS
Streaks of lymphangitis
Gangrene, metastatic abscesses, severe
sepsis
• unusual in immunocompetent adults
• children and immunocompromised are high risk
Diagnosis: CLINICAL
Blood studies, cultures, skin biopsies,
aspirates
• uncommon to be positive
• open wound: culture (+)
C E L LU LIT IS

Streptococci
(75%)
Staphylococci
(25%)
C E L LU LIT IS
Differentials:

Stasis
dermati
tis
C E L LU LIT IS
Differentials:

Does not hurt or

cause fever,
circumferential or
centered over the
medial malleoli,
bilateral
C E L LU LIT IS
Differentials:

Allergic
Stasis
contact
dermatitis
dermatitis
C E L LU LIT IS
Differentials:

Stasis Itchy
dermatit but not
is painful
C E L LU LIT IS
Stasis dermatitis without systemic toxicity
• outpatient
• Dicloxacillin or Cephalexin for 5 days
MRSA
• strongly suspected because of risk factors
• IV Vancomycin or Linezolid
• Community acquired infection:
• Clindamycin
• TMP-SMX (Alone or combined with rifampin)
• Doxycyline + Cephalexin or
• linezolid Penicillin