CLINICAL
DERMATOLOGY
TREATING IMPETIGO
Due to the contagious nature of this disease , utmost care must be taken to limit its spread .
Impetigo is a common , highly contagious , superficial skin infection that primarily affects children . Most lesions occur on the face , however , other body surfaces can also be affected . Impetigo tends to start as small blisters , which becomes filled with pus . These lesions rupture
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and the purulent exudate dries to form golden-coloured crusts . These lesions can be very infectious . Secondary skin infections of existing skin lesions ( cuts , abrasions , insect bites , chickenpox , eczema ) can also occur , leading to an acute , disseminated impetigo . It is commonly caused by S . aureus
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Supiroban is indicated for the topical treatment of primary and secondary bacterial skin infections caused by Staphylococcus aureus and other susceptible organisms . Primary skin infections : impetigo , folliculitis , furunculosis and ecthyma . Secondary infections : Infected dermatoses e . g . infected eczema . Infected traumatic lesions e . g . abrasions , insect bites , minor wounds and burns . Prophylaxis : Supiroban may be used to avoid bacterial contamination of small wounds , incisions and other clean lesions , and to prevent infection of abrasions and small cuts and wounds . Simply apply two to three times a day for up to 10 days , depending on the response . Supiroban is suitable for use by the whole family , making it a perfect addition to emergency home supplies . Trust Supiroban , the antibiotic ointment you can rely on !
Cuts Abrasions Wounds Impetigo Folliculitis Infected eczema
bacteria , Streptococcus pyogenes or mixed infections . Methicillin-resistant S . aureus ( MRSA ) and gentamicinresistant S . aureus strains have also been reported to cause impetigo . Impetigo is classified as either nonbullous ( impetigo contagiosa - about 70 % of cases ) or bullous types .
S2 Supiroban Ointment . Each 1 gram ointment contains : Mupirocin 20 mg . Reg . No .: A 43 / 20.1.6 / 0680 . Classification : A 20.1.6 Topical Antibiotics . Applicant : Glenmark Pharmaceuticals South Africa ( Pty ) Ltd . Reg . No .: 2001 / 020429 / 07 . Unit 7 / 8 York House , Tybalt Place , 185 Howick Close , Waterfall Office Park , Bekker Street , Vorna Valley , Midrand . Marketed by : Activo Health ( Pty ) Ltd . For full prescribing information , refer to approved Package Insert . PMA221 _ 05 / 2016 .
PAEDIATRIC IMPETIGO Children with non-bullous impetigo commonly have multiple coalescing lesions on their face ( perioral , perinasal ) and extremities or in areas with a break in the natural skin defence barrier . The initial lesions are small vesicles or pustules (< 2cm ) that rupture and become a honey-coloured crust with a moist erythematous base . Pharyngitis is absent , but mild regional lymphadenopathy is commonly present . Non-bullous impetigo is usually a selflimiting process that may resolve within two weeks .
Bullous impetigo Bullous impetigo is considered to be less contagious than the non-bullous form . It tends to affect the face , extremities , axillae , trunk , and perianal region of neonates , but older children and adults can also be affected . The initial lesions are fragile thin-roofed , flaccid , and transparent bullae (< 3cm ) with a clear , yellow fluid that turns cloudy and dark yellow . Once the bullae rupture , they leave behind a rim of scale around an erythematous moist base but no crust , followed by a brownlacquered or scalded-skin appearance , with a collarette of scale or a peripheral tube-like rim . Bullous impetigo also differs from non-bullous impetigo in that bullous impetigo may involve the buccal mucous membranes , however regional adenopathy rarely occurs . At times , extensive lesions in infants may be associated with systemic symptoms such as fever , malaise , generalised weakness , and diarrhoea . Rarely , infants may present with signs of pneumonia , septic arthritis , or osteomyelitis . The diagnosis of impetigo is usually made on the basis of the history and physical examination . However , bacterial culture and sensitivity can be used to confirm the diagnosis and are recommended in the following scenarios :
• When MRSA is suspected
• In the presence of an impetigo outbreak
• In the presence of post-streptococcal glomerulonephritis ( PSGN ); in such cases , urinalysis is also necessary .
Impetigo typically is treated with an antibiotic ointment or cream applied directly to the sores . Patients may need to first soak the affected area in warm water or use wet compresses to help remove the scabs so the antibiotic can penetrate the skin . For resistant cases , culture and sensitivity will guide the therapy .
References available on request .
28 MAY 2017 | MEDICAL CHRONICLE