Journal Reading

IMPETIGO: DIAGNOSIS AND TREATMENT

Ahmad Rizky
1102013014

Dosen Pembimbing : dr. Umi Rinasari, MARS, Sp.KK

Kepaniteraan Klinik Ilmu Kulit dan Kelamin

Fakultas Kedokteran Universitas Yarsi
Rumah Sakit Bhayangkara Tk.I R. Said Sukanto
Periode 19 November – 22 Desember 2018
Definition

■ Impetigo is a common bacterial skin infection caused by

Staphylococcus aureus, group A beta-hemolytic Streptococcus
pyogenes, a combination of the two, or less commonly, anaerobic
bacteria
Clinical Presentation

■ There are two presentations of impetigo:

■ Bullous
■ Non-Bullous (also known as impetigo
contagiosa)
NONBULLOUS IMPETIGO

■ Nonbullous impetigo is the most common presentation, comprising 70% of cases

■ can be further classified as primary or the more prevalent secondary (common)
form.
 BULLOUS IMPETIGO
■ caused only by S. aureus and is characterized by large,
fragile, flaccid bullae that can rupture and ooze yellow
fluid (Fig.2)
■ The pathognomonic collarette of scales on its periphery
develops after the bullae rupture, leaving a thin, brown
crust on the remaining erosions (Fig.3)
■ The larger bullae form because of exfoliative toxins produced by S.
aureus strains that cause loss of cell adhesion in the superficial
epidermis
■ typically found on the trunk, axilla, and extremities, and in
intertriginous (diaper) areas.
DIAGNOSIS

■ The diagnosis of nonbullous and bullous impetigo is nearly always

clinical.
■ In patients in whom first-line therapy fails, culture of the pus or
bullous fluid, not the intact skin, may be helpful for pathogen
identification and anti- microbial susceptibilities
COMPLICATIONS

■ Usually a self-limited condition

■ Although it’s rare, still complications can occur
■ Complications include Ecthyma, septicemia, osteomyelitis, septic
arthritis, etc.
TREATMENT

■ Treatment options include topical and systemic antibiotics and topical disinfectants.

■ TOPICAL ANTIBIOTICS
– have the advantage of being applied only where needed, minimizing antibiotic
resistance and avoiding systemic adverse effects

– Three topical antibiotic preparations recommended for impetigo are mupirocin

2% cream or ointment, retapamulin 1% ointment, and fusidic acid
ORAL ANTIBIOTICS

■ Can be used for impetigo with large bullae or when topical therapy is
impractical
■ Treatment for 7 days is usually sufficient, but can be extended
accordingly
TOPICAL DISINFECTANTS

■ There are some studies on the benefits of nonantibiotic treatments,

such as disinfectant soaps, but they lack statistical power.

■ Appears to be less effective than topical antibiotics

NATURAL THERAPIES

■ evidence is insufficient to recommend or dismiss popular herbal

treatments for impetigo
■ Some natural remedies such as Tea tree, Manuka honey, etc, have
been anecdotally successful
FUTURE TREATMENTS

■ Future treatments for impetigo might include minocycline foam

(Foamix), which has successfully completed phase II trials, and
Ozenoxacin, a topical quinolone that has successfully completed
phase III clinical tri- als
THANK YOU