Non-bullous impetigo

Last Updated: 2022-04-01

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

ICD11: 1B72.1

Small-bulb impetigo, non-bullous impetigo.

The non-bullous form is more common than the bullous variant. Usually staphylococci are the trigger, sometimes there is a mixed infection or colonisation with group A streptococci.

Macular erythematous lesions with severe exudation and honey-yellow crusts are seen mainly on the face, especially under the nose, but also in other locations (neck, trunk, hands, etc.). In addition, tense, water-clear vesicles are visible. Often, no primary florescences can be identified. In the course of the disease, healing occurs without scarring.

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  • 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

Mostly on the face, especially under the nose, but also in other locations (neck, trunk, hands, etc.).

Spongiosis and subtle inflammatory reaction of the deeper epithelium. Subcorneal pustule formation (bacteria, fibrin and neutrophil leukocytes).

  • Purulent conjunctivitis
  • Otitis media
  • Postinectic glomerulonephritis
  • Rheumatic fever

  • Do not go to kindergarten or school until 24 hours after the first symptoms are gone!
  • 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
  • Fucidin ointment
  • Mupirocin ointment 2x daily for 5 days
  • Disinfectant poultices

 

Systemic therapy

  • Systemic therapy is indicated in the case of disseminated infestation or the occurrence 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. Kang D, Ran Y, Li C, Dai Y , Lama J. Impetigo-Like Tinea Faciei Around the Nostrils Caused by Arthroderma vanbreuseghemii Identified Using Polymerase Chain Reaction-Based Sequencing of Crusts. Pediatric Dermatology 2012;30:e136-e7. 
  2.  Kikuta H, Shibata M, Nakata S, Yamanaka T, Sakata H, Akizawa K et al. Predominant Dissemination of PVL-Negative CC89 MRSA with SCCmec Type II in Children with Impetigo in Japan. Int J Pediatr 2011;2011:143872. 
  3.  Koning S, Verhagen AP, van Suijlekom-Smit LWA, Morris A, Butler CC , van der Wouden JC. Interventions for Impetigo. The Cochrane Database of Systematic Reviews (Protocol): Wiley-Blackwell; 2001. 
  4.  Liu Y, Kong F, Zhang X, Brown M, Ma L , Yang Y. Antimicrobial susceptibility of Staphylococcus aureus isolated from children with impetigo in China from 2003 to 2007 shows community-associated methicillin-resistant Staphylococcus aureus to be uncommon and heterogeneous. Br J Dermatol 2009;161:1347-50. 
  5.  Mempel M. Impetigo contagiosa. Häufige Hautkrankheiten im Kindesalter: Springer Science + Business Media. p. 49-53. 
  6.  Miller M. Cost-effectiveness of erythromycin versus mupirocin for the treatment of impetigo in children. Annals of Emergency Medicine 1993;22:143. 
  7.  Nishifuji K , Amagai M. [Loss of adhesive function of desmogleins in bullous diseases: pemphigus and impetigo]. Tanpakushitsu Kakusan Koso 2006;51:796-802. 
  8.  Strickland DS. Review: topical mupirocin or fusidic acid may be more effective than oral antibiotics for limited non-bullous impetigo. Evid Based Nurs 2005;8:11