IMPETIGO

By:
Keerthi.V
Roll.No.59
WHAT IS IMPETIGO?

• Impetigo is a bacterial infection that involves the

superficial skin. The most common presentation is
yellowish crusts on the face, arms, or legs. Less commonly
there may be large blisters which affect the groin or
armpits.  The lesions may be painful or itchy.  Fever is
uncommon.
 TYPES OF IMPETIGO:

Two types of impetigo occur:

1. Non bullous impetigo(Impetigo contagiosa)
• Staphylococcal, Streptococcal or combined infection
• Commonest skin infection in children. Face is the most common site.
• It is contagious. (Hence the name impetigo contagiosa)
• Etiology: Overall in the world, staphylococci aureus greater than streptococcus
• pyogens. But in warmer climate, streptococcus is greater than staphylococci.
•
• Starts as very flaccid blisters- rupture soon to create an erosion
covered classically by golden colored/ honey colored crusts.
• Complication: Post streptococcal glomerulonephritis.
• Treatment:
Topical: muciprocin, retapamulin. Fusidic acid.
Oral: dicloxacillin, amoxicillin+ clavulanic acid, cephalexin.
BULLOUS IMPETIGO:

• Also known as pemphigus neonatorum, it is caused by S. aureus.

• S. aureus releases an epidermolytic toxin (ET). This toxin ruptures desmosomes
primarily in subcorneal layer, as the target is desmoglein-1
• The organism can be cultured from blister fluid. The pus settles on lower end of the
blister as it gets heavier- Hypopyon sign.
• When the ET causes local skin infection- called bullous impetigo and when it
disseminates hematogenously- Called staphylococcal scalded skin syndrome(SSSS)
SSSS( RITTER’S DISEASE):

• Generalised, superficially blistering disease in neonates and young children less than 5 yrs
• There is a focus of staph infection (eg. Otitis media or a furuncle from where the ET spreads
hematogenously). Fever is usual.
• Presents typically as perioral scaling and crusting, superficial erosions and absence of mucosal
involvement (Dsg-1 is the target, mucous membrane is not involved since Dsg-1 is absent in mucous
membrane.)
• The blister ruptures and leads to widespread sheet like separation of skin. Skin surface is fragile a d it
shears off easily with finger leaving erosions- Positive Nikolsky sign
• Histopathology- similar to bullous impetigo.
THANK YOU.......