Impetigo/Staphylococcal Scalded Skin Disease.

Abstract

1. Lorena C. Dollani, MD*,†,‡ 2. Kalyani S. Marathe, MD* 1. *Children’s National Medical Center, Washington, DC 2. †Washington Hospital Center, Washington, DC 3. ‡Georgetown University Hospital, Washington, DC Bacterial skin infections are among the most common skin diseases in children. These encompass a range of cutaneous manifestations from localized (bullous impetigo) to systemic (staphylococcal scalded skin disease [SSSS]). The most common pathogen in both nonbullous and bullous impetigo is Staphylococcus aureus . Another important pathogen causing nonbullous impetigo is group A β-hemolytic Streptococcus. SSSS specifically refers to a spectrum of skin diseases induced by the exfoliative toxins of S aureus. The most common pathogen implicated in their pathophysiology is S aureus, which is a gram-positive coccus and can commonly colonize the nose, perineum, eyes, axillae, umbilicus, and wound sites. Impetigo frequently involves children younger than 6 years, accounting for approximately 10% of skin problems observed in pediatric clinics. SSSS is a rare blistering manifestation affecting mainly neonates and young children. Impetigo is an extremely contagious infection that can spread quickly via direct person-to-person contact or through fomites, and its peak incidence is in the summer months. Primary impetigo can result from direct bacterial involvement of the previously normal skin, whereas secondary impetigo is caused by a disruption in the skin barrier that allows the bacteria to adhere, invade, and establish an infection. Causes of secondary impetigo include minor skin trauma secondary to abrasions, cuts, or insect bites or skin infections due to herpes simplex virus or varicella zoster virus. Colonization of the nasopharynx, axillae, and perineal skin with S aureus increases the risk of developing staphylococcal infections. Impetigo is classified as nonbullous or bullous. Whereas nonbullous impetigo …