Inna Mutmainnah Musa Dzul Ikram

(1102090084) (1102090108)

INTRODUCTION
Impetigo is a highly contagious, superficial skin infection that most commonly affects children two to five years of age

Superficial vesicles progress to rapidly enlarging, flaccid bullae with sharp margins and no surrounding erythema. When the bullae rupture, yellow crusts with oozing result.

ETIOLOGY
Bullous impetigo most common is caused by bacterial infection Staphylococcus aureus.

EPIDEMIOLOGY
Often occurs in the neonatal period, but children and young adults also affected. transmitted through direct contact

summer months

poor hygiene and in crowded living conditions.

PATHOGENESIS
S. Aureus elaborates several exvoliative toxins.

exfoliative toxin binding to the desmosomal protein desmoglein 1 and cleaving its extracelluar domain then become the blister formation.

acantholisis within the epidermal granular layer.

CLINICAL FINDINGS
Effloresence
large thin-walled bulla (2 to 5 cm) containing serous yellow fluid margins are sharply demarcated without an erythematous halo. if ruptures leaving a complete or partial denuded area with a ring or arc of remaining bulla.

Predilection Systemic symptom

intertriginous areas such as the diaper area, axillae, and neck folds.

not common but may include weakness, fever, and diarrhea.

DIAGNOSE
Anamnesis
Clinical Finding

Laboratory Examination
Gram staining Bacterial Culture
Blood Count Immunologic examination
show gram positive cocci

reveals group A streptococci, S. aureus or a mixture of streptococci and S.aureus

Mild leucocytosis antideoxyribonuclease B (DNAse- B) titer

DIFFERENTIAL DIAGNOSE
Pemphigus vulgaris

Soft, bullae, thin-walled, fragile, and erythematous.

 Varicella

Thin walled vesicles on an erythematous base that start on trunk and spread to face and extremities.

DIFFERENTIAL DIAGNOSE
Contact Dermatitis

Pruritic areas with with weeping on sensitized skin that comes in contact with haptens.

Disease
Impetigo

Itchy
+

Pain
-

Fever
+/-

Exudate Systemic Effloresence Crust symptom

++ +/The vesicle then becomes brittle bulla then broke into crust. Soft, bullae, thinwalled, fragile, and erythematous.

Pemphigus vulgaris

+/-

++

+/-

Varicella

+/-

Contact Dermatitis

+/-

Vesicles are scattered throughout the body, then become crust. polymorphs lesions (macula erythematous, contained papules, vesicles, bullae)

Treatments
Topical Systemic Prevention
Mupirocin Fusidic acid

Dicloxacilin: 250- 500 mg PO qid for 5- 7 days Amoxicillin: 250 mg daily for 4 days Clindamycin: 150- 300 mg daily

Daily bath Benzoyl peroxide wash (bar) Check family members for signs of impetigo Ethanol or isoprophyl gel for hands and/or involved sites

Prognosa
Untreated, lesions of impetigo progress for several weeks . Untreated or neglected impetigo can progress to ecthyma

With adequate treatment, prompt resolution.

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