Impetigo

Impetigo

The purpose of this discussion is to review impetigo. Impetigo can be mistaken for other skin conditions such as herpes simplex. Therefore, it is necessary to accurately identify what it is. Impetigo is a skin disorder that is superficial in nature. It can spread from person to person and on other parts of the body (Centers for Disease Control and Prevention [CDC], 2020).

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Pathophysiology

The main form of transmission is direct contact. The infection is caused by bacteria (CDC, 2020). Staphylococcus aureus is the main causative agent in older children. Group A beta-hemolytic streptococci also causes impetigo (Hubert & VanMeter, 2018). Interruption in the skin barrier allows the bacteria to access fibronectin receptors in the skin, which is needed for colonization (Nardi & Schaefer, 2020). Infection is further spread by itching due to the irritable nature of the lesions. Autoinoculation with hand creates more vesicles (Hubert & VanMeter, 2018).

The Most Common Presenting Symptoms

Impetigo can be found on any part of the body (CDC, 2020). However, it is mostly seen on the face (Hubert & VanMeter, 2018). Small red vesicles quickly become larger. The vesicles break open and forms a yellowish-brown crust. Liquid with honey colored appearance is seen under the crusts (Hubert & VanMeter, 2018).

Routinely Diagnosed

Impetigo is diagnosed by initial observation of an abnormality in the skin during a physical exam. The diagnosis can be confirmed with a bacterial culture, especially if there is an epidemic or if methicillin-resistant staph aureus (MRSA) is a concern. A biopsy of the skin can be obtained in some cases of untreatable impetigo (Nardi & Schaefer, 2020). Serologic testing for streptococcus antibodies is not done since anti-streptolysin O (ASO) response is not strong enough for diagnosing impetigo in this manner. Nonetheless, it can be used in conditions where

post-streptococcal glomerulonephritis is questioned for patients who had a new outbreak of impetigo (Nardi & Schaefer, 2020). Otherwise lab testing is not needed (CDC, 2020).

Standard Treatment Plan

Impetigo is managed with antibiotics since it is a bacterial infection. Administration of antibiotic drugs is needed in cases where the infection is extensive. Otherwise the topical cream is prescribed when the infection is in a mild state (Hubert & VanMeter, 2018). If left untreated, the infection will resolve on its own. However, treatment with antibiotics decreases complications (Nardi & Schaefer, 2020). Prior to applying topical antibiotic cream, soap and water should be used to remove the crust. The treatment of choice with antibiotic cream are mupirocin, retapamulin, and fusidic acid. Otherwise, preferred treatment with systemic antibiotics are amoxicillin-clavulanate, cephalosporins, dicloxacillin (Nardi & Schaefer, 2020).

Link(s) to Routine Screening and Treatment Guidelines

National screening guidelines for impetigo was not found. However important facts that can benefit both patient and the Advanced Practice Registered Nurse (APRN) are provided in the link below. https://www.health.nsw.gov.au/Infectious/factsheets/Pages/impetigo.aspx

Additionally, Kwak et al. (2017) provided a detailed summary of recommendations for skin and soft tissue infection including impetigo, which can be accessed in the reference.

Treatment guidelines for impetigo is provided in the link below. Clinical features are included.

https://medicalguidelines.msf.org/viewport/CG/english/impetigo-16689666.html

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