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