Bullous impetigo

Last Updated: 2022-04-01

Author(s): Anzengruber F., Navarini A.

ICD11: 1B72.0

Large blistered impetigo contagiosa, bullous impetigo.

Impetigo contagiosa with large flaccid blisters.

  • In large-blistered impetigo, fewer but clearly larger, intact, flaccid blisters appear on a reddened base with water-clear contents. These can also form on unaffected skin. After the blisters have opened, erosions with collerette-like scaling appear. In this variant, the trunk is more frequently affected. The crusting typical of small blister impetigo is absent. In the course of the disease, healing without scarring occurs.
  • Fever, reduced general condition and nausea can rarely occur.
  • When the local findings are pronounced, one speaks of a pemphigoid staphylogenes of the newborn, a special form of large-bubble impetigo. Although the term is hardly used today, this variant is also known as pemphigus contagiosus, pemphigus acutus neonatorum, peeling blisters and exanthema bullosa neonatorum.

  • Clinical presentation
  • Bacterial smear
  • ASL titer, ASO titer
  • Urinanalysis (to rule out glomerulonephritis), follow-up after 2-4 weeks recommended
  • In adults, HIV infection should be excluded

Similar to small vesicular impetigo, but here there is intraepidermal blistering.

Staphylococcal Scalded Skin Syndrome.

  • No attendance at kindergarten or school until 24 hours after the first symptom-free period!
  • Strict hygiene!
  • Change towels and bed linen frequently and wash at a minimum of 60°C, preferably 90°C
  • Infested skin areas should be covered
  • At a body temperature of > 38°C take blood cultures

 

Topical therapy

  • Only topical therapy is indicated for solitary lesions
  • Retapamulin ointment
  • Fucidin ointment
  • Mupirocin ointment 2x daily for 5 days
  • Disinfectant poultices

 

Systemic therapy

  • Systemic therapy is indicated for disseminated infestation or the appearance of general symptoms (fever, pain in the limbs, lymphadenopathy)
  • Augmentin p.o. 625 (500/125) mg 3x daily (adults and children > 40 kg)
  • Cefuroxime p.o. 250-500 mg 2x daily (> 12 yrs), 125 mg 2x daily (5-12 yrs and ≥ 15 kg); i.v. 750 mg-1.5 g 3-4x daily
  • Erythromycin p.o. 500 mg 3x daily, maximum dose: 4 g/d (adult), 40-100 mg/kg bw/day (5-12 yrs)

 

In case of relapse:

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

 

In case of itching:

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

 

  1. Albert S, Baldwin R, Czekajewski S, Van Soestbergen A, Nachman R, Robertson A. Bullous impetigo due to group II Staphylococcus aureus. An epidemic in a normal newborn nursery. Am J Dis Child 1970;120:10-3.
  2. Alcalay J, David M, Sandbank M. Bullous impetigo and localized scalded skin syndrome in the elderly. Isr J Med Sci 1987;23:300-1.
  3. Al-Hammadi H, Al Hammadi A. Dermacase. Bullous impetigo. Can Fam Physician 2008;54:193, 7.
  4. Bloom MW, Carter EL. Bullous impetigo of the face after epilation by threading. Arch Dermatol 2005;141:1174-5.
  5. Brook I. Bullous impetigo caused by Streptococcus salivarius: a case report. J Clin Pathol 1980;33:1099-101.
  6. Helsing P, Gaustad P. Bullous impetigo caused by group A streptococci. A case report. Acta Derm Venereol 1992;72:50-1.
  7. Lissauer TJ, Sanderson PJ, Valman HB. Re-emergence of bullous impetigo. Br Med J (Clin Res Ed) 1981;283:1509-10.
  8. Scales JW, Fleischer AB, Jr., Krowchuk DP. Bullous impetigo. Arch Pediatr Adolesc Med 1997;151:1168-9.
  9. Someshwar S, Jerajani HR. Bullous impetigo. Indian Pediatr 2014;51:243.