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4. Skin diseases
Bacterial skin infections
Impetigo
– Im p etigo is a ben ign , con tagious in fection of the ep id erm is d ue to group A ß-
haem olytic
strep tococcus an d Staphylococcus aureus. C o-in fection is com m on . T ran sm ission is
by
d irect con tact. L ack of w ater an d p oor hygien e in crease sp read .
– P rim ary in fection s are m ost com m on in child ren . S econ d ary in fection s
com p licatin g
p re-existin 4g p ruritic d erm atoses (lice, scabies, ecz em a, h erp es, chick en p ox etc.)
are
m ore com m on in ad ults.
Clinical features
– C lassic form : flaccid vesicule on eryth em atous sk in w h ich becom es p ustular an d
form s a yellow ish crust. D ifferen t stag es of th e in fection m ay b e p resen t
sim ultan eously. T he lesion d oes n ot leave a scar. T he m ost com m on sites of in fection
are aroun d the n ose an d m outh, on the lim bs or on the scalp . T here is n o fever.
– B ullous im p etigo: large flaccid bullae an d erosion s of th e sk in in th e an o- gen ital
region in n ew born s an d in fan ts.
– E cthym a: an ulcerative form of im p etigo that leaves scars. L esion s usually occur on
the low er lim bs. T his form is m ost com m on in the im m un ocom p rom ised , d iabetics
an d alcoholics.
– R are com p lication s:
•abscess, p yod erm itis, lym p han gitis, osteom yelitis, sep ticaem ia;
•system atically look for sign s of acute glom erulon ep hritis.
Treatment
– Localised impetigo (less than 3 lesion s on the sam e region of the bod y):
•C lean w ith soap an d w ater 2 tim es/ d ay an d d ry.
• S often crusts if p resen t by ap p lyin g vaselin e an d gen tly rem ove them .
•K eep d ry (d o n ot cover w ith an occlusive d ressin g; if on the buttock s of child ren ,
leave un covered , etc.).
•K eep fin gern ails short.
– Extensive impetigo (m ore than 3 lesion s or im p etigo on m ore than on e region of the
bocdloyx)a,cbilulilnloPusOim p etigo, ecthym a, abscess; im m un ocom p rom ised p atien t:
•T reat locally as above.
•In cise abscesses.
•T reat w ith an tibiotics:
C hild ren : 5 0 m g/ k g/ d ay in 3 d ivid ed d oses for 7 d ays
A d ults: 3 g/ d ay in 3 d ivid ed d oses for 7 d ays
Bacterial skin infections
Impetigo
– Im p etigo is a ben ign , con tagious in fection of the ep id erm is d ue to group A ß-
haem olytic
strep tococcus an d Staphylococcus aureus. C o-in fection is com m on . T ran sm ission is
by
d irect con tact. L ack of w ater an d p oor hygien e in crease sp read .
– P rim ary in fection s are m ost com m on in child ren . S econ d ary in fection s
com p licatin g
p re-existin 4g p ruritic d erm atoses (lice, scabies, ecz em a, h erp es, chick en p ox etc.)
are
m ore com m on in ad ults.
Clinical features
– C lassic form : flaccid vesicule on eryth em atous sk in w h ich becom es p ustular an d
form s a yellow ish crust. D ifferen t stag es of th e in fection m ay b e p resen t
sim ultan eously. T he lesion d oes n ot leave a scar. T he m ost com m on sites of in fection
are aroun d the n ose an d m outh, on the lim bs or on the scalp . T here is n o fever.
– B ullous im p etigo: large flaccid bullae an d erosion s of th e sk in in th e an o- gen ital
region in n ew born s an d in fan ts.
– E cthym a: an ulcerative form of im p etigo that leaves scars. L esion s usually occur on
the low er lim bs. T his form is m ost com m on in the im m un ocom p rom ised , d iabetics
an d alcoholics.
– R are com p lication s:
•abscess, p yod erm itis, lym p han gitis, osteom yelitis, sep ticaem ia;
•system atically look for sign s of acute glom erulon ep hritis.
Treatment
– Localised impetigo (less than 3 lesion s on the sam e region of the bod y):
•C lean w ith soap an d w ater 2 tim es/ d ay an d d ry.
• S often crusts if p resen t by ap p lyin g vaselin e an d gen tly rem ove them .
•K eep d ry (d o n ot cover w ith an occlusive d ressin g; if on the buttock s of child ren ,
leave un covered , etc.).
•K eep fin gern ails short.
– Extensive impetigo (m ore than 3 lesion s or im p etigo on m ore than on e region of the
bocdloyx)a,cbilulilnloPusOim p etigo, ecthym a, abscess; im m un ocom p rom ised p atien t:
•T reat locally as above.
•In cise abscesses.
•T reat w ith an tibiotics:
C hild ren : 5 0 m g/ k g/ d ay in 3 d ivid ed d oses for 7 d ays
A d ults: 3 g/ d ay in 3 d ivid ed d oses for 7 d ays
