How to Diagnose

Bullous Impetigo
 How to Diagnose

Vital Sign &

Physical Sign

Anamnesis Supporting
Investigation
Anamnesis
KT:
 In infants, it can be accompanied by general symptoms such as: fever, weakness, and
diarrhea.

 History of the same complaint previously

 History of skin disease
 Allergy history
 Family Disease History
 History of the same complaint with the patient
 History of use of certain drugs
 History of direct contact with sufferers of the same disease
 Nutrition history
 Environmental history
 Vital Sign and Physical Sign
Dermatology Examination
 Localization: in areas of skin folds, such as in the neck, armpits, and
groin. Skin disorders can spread to other areas of the skin due to
scratching sufferers.

 Efloresence: looks like a bull with a thick wall and thin, billion to
lenticular, surrounding skin is not showing inflammation is sometimes
seen hypopyon.
 Supporting Investigation

 Microbiological examination:

 Gram stain of the exudate gives a gram-positive result

 Exudate collected from the bottom of the crust and fluid from the bulla can be cultured
and tested for sensitivity. Culture results may show Staphylococcus pyogenes,
Staphylococcus Aureus or both.

 Routine laboratory

 On routine blood tests, mild leukocytosis is found in only 50% of cases of patients
with impetigo.
Supporting Investigation

 Immunological examination

 In impetigo caused by streptococcus can be found increased levels of anti-

deoxyribonuclease (anti DNAse) B antibodies.

 Histopathological picture

 the epidermis appears subcorneal vesicles filled with inflammatory cells viz
leukocytes. In the dermis looks sebuk cells mild inflammation and widening of the
ends of the vessels blood.
REFERENCE

 Hartman-Adams, H., C. Banvard, and G. Juckett, Impetigo: diagnosis and treatment. Am Fam
Physician, 2014. 90(4): p229-35.

 Stevens, D. and A. Bryant, Impetigo, Erysipelas and Cellulitis, in Streptococcus pyogenes : Basic
Biology to Clinical Manifestations J. Ferretti, D. Stevens, and V. Fischetti, Editors. 2016:
Oklahoma City (OK): University of Oklahoma Health Sciences Center.

 Castro MCR, Ramos-E-Silva M. Infeksi kulit pada pasien dewasa. Klinik Dermatol. 2018 Mar-
Apr; 36 (2):188-196. [ PubMed ]