Impetigo contagiosa

• Children between 2-5 years of age are particularly affected
• Most common bacterial disease in children
• Can cause endemics in schools and kindergartens
• Predisposing factors:
  • Atopic eczema
  • Scabies
  • Wind pox
  • Warm, humid climate
  • Poverty
  • Living with many people
  • Poor hygiene

• Staphylococci produce exfoliative toxins which act as serine proteases attacking desmoglein 1. This causes acantholysis of the str. granulosum (also called localised staphylococcal scalded skin syndrome or staphylogenic Lyell syndrome)

• Division
  • Non-bullous form
  • Bullous form

• Primary infections: Infestation of healthy skin
• Secondary infections (impetiginisation): infestation of previously damaged skin (injuries, atopic eczema, scabies etc.)

• Incubation period: 2-10 days

Aetiopathogenesis

• Transmission occurs through smear infection or direct body contact. In rare cases, objects may also serve as a source of infection. Continuous sniffing can damage the skin and facilitate infection

• Clinic
• Bact. smear
• ASL titer, ASO titer
• U status (e.g. of glomerulonephritis), follow-up after 2-4 weeks recommended
• In adults, HIV infection should be excluded

• Post-infectious glomerulonephritis
• Rheumatic fever
• Purulent conjunctivitis
• Otitis media

Remediate nasal vestibule, strengthen personal hygiene

Healing after 1-2 weeks.

Topical therapy:

• Chlorhexidine topical 2x tgl (Bepanthen plus)
• Antiseptic wash solution (chlorhexidine LifoScrub, triclosan Procutol) 1x tgl
• Fucidic acid 2x tgl (fucidin ointment), can produce resistance

Systemic therapy

• Systemic therapy is indicated for disseminated infestation or the occurrence of general symptoms (fever, pain in the limbs, lymphadenopathy)
• Augmentin p.o. 625 (500/125) mg 3x tgl (adults and children > 40 kg)

In case of relapse:

• Possible chronic germ carrier Bact. smear (nose, perianal)!

In case of itching:

• Sedating antihistamines:
  • Clemastine p.o. 1 tbl. 1x tgl.
• Non-sedating antihistamines:
  • Desloratadine p.o. 1 tbl. 1x tgl.

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