Cases Of Impetigo Research Articles

Prevalence and associated risk factors of scabies and impetigo: A cross-sectional study in Tutume district, Botswana.

The epidemiology of scabies is poorly understood, particularly in regions with high disease burden. This lack of epidemiological data, especially in sub-Saharan Africa, hampers the control and preventative measures. This study is aimed at estimating the prevalence and associated risk factors of scabies and impetigo in the Nata and Sowa catchment areas of Tutume district. A cross-sectional study was conducted in the Tutume District, targeting the settlements of Manxhotae, Malelejwe, Ndutshaa, and Tshwaane. Participants were randomly selected from households in the settlements. Data were collected using questionnaires, and participants were classified as having scabies typical lesions if they met criteria B and or C of International Alliance for the Control of Scabies (IACS) consensus criteria. Statistical significance was set at p<0.05, with a 95% confidence interval for precision. A total of 429 participants were enrolled across the four settlements. The overall prevalence of scabies was found to be 18.18% (95%CI 14.8-22.1). The highest prevalence of scabies was in Manxhotae at 27.1% (95%CI 21.2-34.0) and Ndutshaa at 23.4% (95%CI 13.4-37.3). Malelejwe and Tshwaane had lower prevalence of 10.4% (95%CI 6.2-16.8) and 3.4% (95%CI 0.8-12.7), respectively. Only five (5) cases of impetigo were identified. Multivariable logistic regression analysis revealed that younger age of 0-4 years, 5-18 years and a household member with an itch were strongly associated with scabies, with adjusted odds ratios (aOR) of 7.9 (95%CI 2.4-25.6) p-value 0.001, 5.7(95%CI 2.7-11.7), p-value 0.001 and 14.3(95%CI 5.3-38.5) p-value 0.001 respectively. The prevalence of scabies in the Nata catchment area was noted to be high. The risk factors included younger age, a household member with an itch, and less frequent bathing. Prospective studies are needed to explore household disease transmission dynamics and risk factors specific to the youth.

Persistence of the Staphylococcus aureus epidemic European fusidic acid-resistant impetigo clone (EEFIC) in Belgium.

In August 2018, a public health alert was issued in Belgium regarding clusters of impetigo cases caused by the epidemic European fusidic acid-resistant impetigo clone (EEFIC) of Staphylococcus aureus. As a result, the Belgian national reference centre (NRC) was commissioned to update the epidemiology of S. aureus causing community-onset skin and soft tissues infection (CO-SSTI) to assess the proportion of EEFIC among them. For 1 year, Belgian clinical laboratories were asked to send their first three S. aureus isolated from CO-SSTI each month. Isolates were tested for antimicrobial susceptibility to oxacillin, mupirocin and fusidic acid. Resistant isolates were also spa typed and tested for the presence of the genes encoding the Panton-Valentine leucocidin, the toxic shock syndrome toxin and the exfoliatins A and B. MLST clonal complexes were deduced from the spa types. Among the 518 S. aureus strains analysed, 487 (94.0%) were susceptible to oxacillin. Of these, 79 (16.2%) were resistant to fusidic acid, of which 38 (48.1%) belonged to the EEFIC. EEFIC isolates were mostly isolated from young patients with impetigo and showed a seasonal late summer peak. These results suggest the persistence of EEFIC in Belgium. Furthermore, its prevalence may lead to reconsideration of the treatment guidelines for impetigo.

Evaluating the role of asymptomatic throat carriage of Streptococcus pyogenes in impetigo transmission in remote Aboriginal communities in Northern Territory, Australia: a retrospective genomic analysis

Streptococcus pyogenes, or group A Streptococcus (GAS), infections contribute to a high burden of disease in Aboriginal Australians, causing skin infections and immune sequelae such as rheumatic heart disease. Controlling skin infections in these populations has proven difficult, with transmission dynamics being poorly understood. We aimed to identify the relative contributions of impetigo and asymptomatic throat carriage to GAS transmission. In this genomic analysis, we retrospectively applied whole genome sequencing to GAS isolates that were collected as part of an impetigo surveillance longitudinal household survey conducted in three remote Aboriginal communities in the Northern Territory of Australia between Aug 6, 2003, and June 22, 2005. We included GAS isolates from all throats and impetigo lesions of people living in two of the previously studied communities. We classified isolates into genomic lineages based on pairwise shared core genomes of more than 99% with five or fewer single nucleotide polymorphisms. We used a household network analysis of epidemiologically and genomically linked lineages to quantify the transmission of GAS within and between households. We included 320 GAS isolates in our analysis: 203 (63%) from asymptomatic throat swabs and 117 (37%) from impetigo lesions. Among 64 genomic lineages (encompassing 39 emm types) we identified 264 transmission links (involving 93% of isolates), for which the probable source was asymptomatic throat carriage in 166 (63%) and impetigo lesions in 98 (37%). Links originating from impetigo cases were more frequent between households than within households. Households were infected with GAS for a mean of 57 days (SD 39 days), and once cleared, reinfected 62 days (SD 40 days) later. Increased household size and community presence of GAS and scabies were associated with slower clearance of GAS. In communities with high prevalence of endemic GAS-associated skin infection, asymptomatic throat carriage is a GAS reservoir. Public health interventions such as vaccination or community infection control programmes aimed at interrupting transmission of GAS might need to include consideration of asymptomatic throat carriage. Australian National Health and Medical Research Council.

Retrospective Analysis of the Real-World Use of Topical Antimicrobials in the Paediatric Population with Impetigo in Italy: Focus on the Role of Ozenoxacin 1% Cream.

Using electronic data from a large population-based network of Family Paediatricians (Pedianet), we aimed to describe the use of topical antimicrobials, including ozenoxacin 1% cream, in impetigo in children in Italy. We included 2929 children aged 6 months-14 years from 2016 to 2019 with at least one episode of impetigo treated with topical antimicrobials. Overall, 3051 cases of impetigo were included in the analysis. Treatment started in most cases on the same day as the impetigo diagnosis and lasted around eight days. In about 8% of the cases, a systemic antibiotic was prescribed after the topical antimicrobial, usually after 4-14 days. In this study, ozenoxacin was used in 8% of the cases. Treatment duration was significantly shorter for patients prescribed ozenoxacin compared to the whole study population (median of six vs. seven days, respectively). In contrast, the rate of treatment failure was similar. Very few adverse reactions were identified.

A Case of Impetigo on Nose Treated with Homoeopathic Medicine Rhus Toxicodendron

A child visited the OPD with a crusty lesion on the nose like exanthema causing much burning & itching. According to symptoms and clinical manifestation, it was diagnosed as a case of Impetigo, a common infection of the superficial layers of the epidermis. It is most commonly caused by gram-positive bacteria. The patient may present with erythematous plaques with a yellow crust and may be itchy or painful. The lesions are highly contagious and spread easily. Diagnosis is typically based on the symptoms and clinical manifestations alone. The diagnosis was provisionally made at Model AYUSH OPD(Homoeopathy), State Homoeopathic Dispensary, Bagdogra. To confirm the diagnosis, the expert opinion of the Hospital Superintendent cum Block Medical Officer Health (BMOH) at Rural Hospital, Naksalbari Block, was taken. Treatment was completed successfully within 7 days. Rhus Tox 200, 6 doses were prescribed to be taken twice a day for 3 days, followed by placebo. The prescription was done on the basis of skin symptoms- Exanthema on the face in general-on chin, face, cheeks, mouth, nose, and forehead, causing much burning & itching, ameliorated by warmth.

PASSION Project: Data Collection in Madagascar and Guinea

Background Little data on dermatological conditions presenting on African skin are currently available. This is partly due to the lack of dermatologists in African countries, such as Madagascar and Guinea. There are only 13 dermatologists in Madagascar, or one dermatologist for every 2 million inhabitants. By contrast, the prevalence of common dermatosis is constantly increasing, especially among the pediatric population. According to the World Health Organization, 80% of these skin problems in Africa are grouped into the following 5 pathologies: atopic dermatitis, dermatophytosis, scabies, impetigo, and insect bites. Objective In the face of this dilemma, artificial intelligence (AI) is a better tool to collect data on a national scale. Madagascar began participating in the PASSION project in June 2020 and Guinea began participating in January 2021. They join other countries, like Switzerland, Australia, China, India, and Tanzania, who are also using AI in dermatology. This study mainly aimed to compare the 5 pathologies according to the different phototypes characterizing these countries and to collect cases on a national scale that will form a national database. The aim of the data collection is to add 1000 cases per year to the database. Methods To increase the number of cases included in phototypes III to VI, two countries were included. A total of 6 data collection sites were set up in Madagascar and one was set up in Guinea. Patients were recruited during dermatology consultations. All patients presenting the 5 pathologies were included. A total of 3 platforms were used to collect data: my.crf.one, IntelliStream, and Derma2go. Results A total of 323 cases are currently included in the database for Madagascar, including 76 cases of scabies, 111 cases of atopic dermatitis, 94 cases of dermatophytosis, 35 cases of impetigo and 11 cases of insect bites. The patients’ ages ranged from 2 months to 68 years. A male predominance was noted, with a sex ratio of 1.19 (109 males and 91 females). Phototypes ranged from III to VI. For Guinea, 178 total cases included 32 cases of scabies, 26 cases of atopic dermatitis, 92 cases of dermatophytosis, 3 cases of impetigo, and 25 cases of insect bites. Patients’ ages ranged between 1 year and 70 years, with a male predominance, a sex ratio of 1.54 (108 males and 70 females), and a predominance of phototype VI. Conclusions AI is a data collection solution in Africa. However, high bandwidth is needed to employ AI. Conflicts of Interest None declared.

The Use of Ozenoxacin in Pediatric Patients: Clinical Evidence, Efficacy and Safety.

Impetigo is the most common childhood skin infection in the world. There are two patterns of impetigo: nonbullous (or impetigo contagiosa) and bullous. The nonbullous type is due to Staphylococcus aureus and group A beta-haemolytic Streptococcus and occurs in 70% of impetigo cases. Impetigo is often a self-limited disease, but complications can sometimes occur. Therapy depends on the extent and site of the lesions and on the presence of systemic symptoms. The increase in multidrug resistance pathogens, such as methicillin-resistant Staphylococcus aureus, mupirocin-resistant Staphylococcus aureus or quinolone-resistant Staphylococcus aureus, requires the development of new antibiotics against these agents. The aim of this review is to evaluate the efficacy and safety of ozenoxacin in children compared to those of other approved topical antimicrobial therapies. The bactericidal activity against both susceptible and resistant organisms is a relevant feature of ozenoxacin because the bacterial strain and potential for resistance are generally not known at the beginning of therapy. Additionally, its minimal dermal absorption and its capability to reach high concentrations in the upper layers of the epidermidis agrees with the recommended practice aimed at avoiding the emergence of bacterial resistance in presence of a good safety profile. Further studies with real-life analyses and pharmacoeconomic evaluation are needed to confirm its role as first-line and second-line therapy in children with impetigo.

A case of impetigo cured with Homoeopathic similimum

A case of impetigo cured with Homoeopathic similimum

Prevalence, Clinical Features and Antibiotic Susceptibility of Group A Streptococcal Skin Infections in School Children in Urban Western and Northern Uganda.

Group A Streptococcus (GAS) skin infections can lead to invasive sepsis, poststreptococcal glomerulonephritis, and potentially rheumatic heart disease (RHD). Within a study to identify predisposing factors of RHD in Ugandan schoolchildren, we determined the prevalence of skin infections and assessed the clinical features and antibiotic susceptibility of GAS skin infection. Cross-sectional study conducted at 3 urban primary schools in Western and Northern Uganda in March 2017. A dermatologist rendered clinical diagnoses and obtained a skin swab specimen from lesions with signs of bacterial infection. Beta-hemolytic colonies underwent Lancefield grouping, species identification by polymerase chain reaction and antimicrobial susceptibility testing. From 3265 schoolchildren, we observed 32% with ≥1 fungal, 1.8% with ≥1 bacterial, 0.9% with ≥1 viral, and 0.2% with ≥1 ectoparasitic infection. Of 79, 25 (32%) specimens were GAS-positive, of which one-third demonstrated tetracycline resistance. Of 17 impetigo cases, 13 (76%) were located on the leg/foot and 3 (18%) on the head/neck. Prevalence of GAS skin infection was 0.8% (25 of 3265). In Northern Uganda, where subclinical definite RHD prevalence is 1.1%, GAS skin infection prevalence was 1.2% (4 of 343) and 0.9% (3 of 352). This study identifies tetracycline-resistant GAS in Ugandan communities, suggests modified skin examination of exposed anatomic locations may be appropriate for population-based GAS skin infection studies, and underscores need for clear case definitions of GAS skin infection. Future studies are needed to evaluate the role of GAS skin infection in development of RHD in Ugandan communities.

The prevalence of dermatological infection in outpatient dermatology clinic of RSUD Wonosari in January-September 2016

Background : The Skin is a complex organ that protects humans from their surrounding environment, like an infectious pathogenic agent, sunlight exposure, temperature, or other exposures. Skin infections can be divided into bacterial, viral, or fungal infections where infestations of bugs or worms are included. In Indonesia, the exact number of skin infection incidents has not been established. And until now, there are no research reports about the case pattern of skin infections in the area of Kabupaten Gunung Kidul in 2016. Objective : This research aimed to describe the overview of skin infection cases in Outpatient Dermatology Clinic of RSUD Wonosari, Gunung Kidul fromJanuary 2016 until September 2016. Methods : This research was conducted retrospectively based on medical records of all cases of skin infections in Outpatient Dermatology Clinic of RSUD Wonosari during the period of January 2016 - September 2016. Results : All new cases of skin infections in outpatient dermatology clinic of RSUD Wonosari within the period of January 2016 - September 2016 amounted to 303 cases. The cases consisted of 127 cases of fungal infection (42%) with a variety of cases of dermatophytosis, PVC, and candidiasis; 55 cases of bacterial infections (18%) with a variety of cases of impetigo, folliculitis, leprosy, ektima, erysipelas, furuncles, and abscesses; 40 cases of viral infections (13%) with variaty of cases of HFMD cases, Moluscum contagiosum, zooster, warts, varicella; and 81 cases of parasitic infections (27%) with a variety of cases of scabies, creeping eruption, and pediculosis capitis. Conclusion : Skin diseases caused by infections was still a dominant skin disease in the outpatient Dermatology clinic of RSUD Wonosari, with the number of cases 18.35% of all cases of skin and venereal diseases. The most common cause is infection by fungi (7.69%), followed by parasitic infections, scabies (4.91%), bacterial infections (3.33%), and viral infections (2.42%).

The Prevalence, Molecular Characterization and Antimicrobial Susceptibility of S. aureus Isolated from Impetigo Cases in Duhok, Iraq

Background:Staphylococcus aureusis one of the most important opportunistic pathogens. Impetigo is the common contagious bacterial infection of the skin caused byS. aureus.Method:Samples were taken from 204 patients with impetigo disease.S. aureusisolates were tested for their antimicrobial susceptibility. Genomic DNA ofS. aureuswas used to transformE. coliHB101 strain and expression capability ofS. aureusplasmids in transformedE. coliwas investigated. 68.62% (140/204) of the specimens were nonbullous impetigo and 31.38% (64/204) were bullous impetigo.S. aureusstrains were isolated from 41.66% (85/204) of impetigo cases (82.35% from nonbullous and 17.65% from the bullous impetigo). There was an inverse relationship between the incidence ofS. aureusisolated and age.Result:Three biotypes ofS. aureuswere identified based on their fermentation of different sugars. All isolates were resistant to penicillin and most isolates were resistant to ampicillin (95.3%), amoxicillin, (94.11%) and cephalexin (90.95%). Most isolates were sensitive against vancomycin and rifampicin (98.83%). 5.88% (5/85) ofS. aureusisolates were identified as MRSA. A maximum of 5 markers fromS. aureusisolates were capable to be expressed in transformedE. coliHB101 strains. The incidence of impetigo caused byS. aureusis comparable with reports from elsewhere.S. aureusisolates showed multidrug resistance against antibiotics.Conclusion:Plasmids ofS. aureusare capable to show its expression inE. coliHB101. Molecular study is needed to investigate the role of plasmids in different patterns of multi drug resistance.

The Prevalence of Scabies and Impetigo in the Solomon Islands: A Population-Based Survey.

BackgroundScabies and impetigo are common, important and treatable skin conditions. Reports from several Pacific island countries show extremely high prevalence of these two conditions, but for many countries, including the Solomon Islands, there is a paucity of epidemiological data.MethodologyTen rural villages in the Western Province of the Solomon Islands were included in the study, chosen so that data collection could be integrated with an existing project investigating clinical and serological markers of yaws. All residents were eligible to participate, and 1908 people were enrolled. Participants were interviewed and examined by a paediatric registrar, who recorded relevant demographic information, and made a clinical diagnosis of scabies and/or impetigo, severity and distribution.Principal FindingsThe total unweighted prevalence of scabies was 19.2% (95% confidence interval [CI] 17.5–21.0), and age and gender weighted prevalence 19.2% (95%CI 16.7–21.9). The adult prevalence of scabies was 10.4% (95%CI 8.2–13.2), and the highest prevalence was found in infants < 1 year of age (34.1%, adjusted odds ratio [AOR] compared with adults: 3.6, 95%CI 2.2–6.0) and children aged 1–4 years (25.7%, AOR 2.6, 95%CI 1.7–3.9). Scabies affected two or more body regions in 80.9% of participants, and 4.4% of scabies cases were classified as severe. The total unweighted prevalence of active impetigo was 32.7% (95%CI 30.6–34.8), and age and gender weighted prevalence 26.7% (95%CI 24.2–29.5). The highest prevalence was found in children aged 1–4 years (42.6%, AOR compared with adults: 4.1, 95%CI 2.9–5.8). Scabies infestation was associated with active impetigo infection (AOR 2.0, 95%CI 1.6–2.6); with 41.1% of active impetigo cases also having scabies.Conclusions and SignificanceScabies and impetigo are very common in the rural Western Province of the Solomon Islands. Scabies infestation is strongly associated with impetigo. Community control strategies for scabies may reduce the burden of both conditions and their downstream complications.

Childhood skin and soft tissue infections: new discoveries and guidelines regarding the management of bacterial soft tissue infections, molluscum contagiosum, and warts.

Pediatric skin and soft tissue infections (SSTIs) constitute a significant number of office-based pediatric visits. With SSTIs on the rise, it is not only important to effectively treat the individual, but to do so appropriately and cost-consciously. In this article, we highlight new research related to the treatment of bacterial skin infections, molluscum contagiosum, and cutaneous warts, with the goal of guiding pediatricians in their practice against these common skin conditions. Recent data supports the use of topical antibiotics for noncomplicated impetigo. Systemic antibiotics covering gram-positive cocci are recommended for complicated cases of impetigo and deeper nonpurulent SSTIs. Localized purulent bacterial SSTIs can be treated with incision and drainage alone but more systemic involvement warrants treatment with systemic antibiotics covering Staphylococcus aureus species, especially community acquired methicillin-resistant S. aureus. For the treatment of molluscum contagiosum, topical cantharidin has a high satisfaction rate among patients and providers. Potassium hydroxide solution is a potentially effective and cheap form of molluscum contagiosum treatment. Imiquimod, however, has an unfavorable efficacy and safety profile as a therapy for molluscum contagiosum. Regarding warts, high-risk human papilloma virus strains have been detected in cutaneous warts in children. The high-risk human papilloma virus vaccine may play a role in treating pediatric cutaneous warts in the future, and topical squaric acid dibutylester may effectively treat recalcitrant warts. Finally, both molluscum contagiosum and warts have a high rate of resolution after an extended period of time without any intervention.

The decline of the impetigo epidemic caused by the epidemic European fusidic acid-resistant impetigo clone: an 11.5-year population-based incidence study from a community in Western Norway.

BackgroundFrom around the year 2000, Northern Europe experienced a rise in impetigo caused by Staphylococcus aureus resistant to fusidic acid. A single clone of S. aureus was found to be the bacterial pathogen involved in the impetigo outbreak in Norway, Sweden, the UK and Ireland, termed ‘the epidemic European fusidic acid-resistant impetigo clone’ (EEFIC). We have followed the incidence of impetigo during the years 2001–2012 based on all patients in general practice in the island community of Austevoll, Western Norway. We previously reported a marked decline of impetigo incidence in Austevoll, from 0.0260 cases per person-year in 2002 to 0.0038 in 2009. This article explores indications of an end to the impetigo epidemic caused by the EEFIC clone. Methods: All four general practitioners (GPs) in the community (mean population = 4400) were asked to diagnose impetigo in a uniform way and to take bacterial specimens from all impetigo cases. Phenotypic characteristics of specimen bacteria were determined for the whole period and molecular analyses were performed on isolates in the period 2008–2012. Results: We observed a further decline in incidence of impetigo in Austevoll in the study period. The proportion of fusidic acid-resistant S. aureus isolates decreased during the period 2002–2012, with a mean of 80% in the epidemic years of 2002–2004, 55% in 2005–2009, and 6% in 2010–2012. In total, 44 S. aureus isolates from impetigo were subject to molecular analyses in the period 2008–2012, and 11 were found to be related to the EEFIC. All EEFIC isolates were found in 2008–2009, with no new isolates in 2010–2012. Conclusion: There is an apparent end to the impetigo epidemic related to the EEFIC in this population in Western Norway.

Short flap rhytidectomy and fractional CO2 laser rejuvenation of the aging face

There is currently a high demand for a concurrent system of skin rejuvenation accompanying rhtidectomy. CO2 laser treatment prior to surgical ablative reduction has produced promising results, but the adjunct service of laser treatment at the time of surgery has never been reviewed. Determine the effects of concurrent treatment of rhytides and evidence of aging in the skin with surgical correction followed by fractional CO2 laser application. During study time from September 2008 to February 2009 treat patients who have underwent short flap rhytidectomy to the Lutronic eCO2™ fractional laser using the patented "Controlled Chaos Technology." Complications included 2.3% herpes simplex outbreak, 4% persistent erythema past 2 weeks, four cases of prolonged edema to 5 days, one case of impetigo, and no evidence of dyspigmentation. Patient satisfaction data demonstrated no refunds at 12 months. Combination fractional laser resurfacing with short flap, high-Superficial muscular aponeurotic system rhytidectomy is a safe procedure with excellent patient satisfaction and clinical outcomes.

Impetigo in children: a clinical guide and treatment options

AbstractImpetigo is a contagious, superficial bacterial infection of the skin, most frequently encountered in children. Causative organisms are almost always Staphylococcus aureus or streptococci, or a combination of the two. Predisposing factors are nasal and perineal colonisation, overcrowding, poor personal hygiene, minor skin trauma and pre-existing skin diseases with disrupted skin barrier function, like eczema. Infection is mainly acquired through contact with sufferers or nasal carriers. Treatment should be given to avoid spread of the disease, and to minimise the risk of infecting others. Although the majority of cases of impetigo are self-limiting, under certain circumstances complications like toxic shock syndrome, staphylococcal osteomyelitis, septic arthritis and pneumonia can occur. Furthermore, certain strains of group A β-haemolytic streptococci causing impetigo may result in poststreptococcal glomerulonephritis, just like streptococcal throat infections can result in rheumatic fever in chi...

Impetigo in epidemic and nonepidemic phases: an incidence study over 4½ years in a general population

Little is known about incidence and natural variation of impetigo in general populations. To investigate the natural course of impetigo in a well-defined population, and to study the resistance pattern of the causal bacteria over time. This is a population-based incidence study in Austevoll, an island community of 4457 inhabitants in Norway, in the years 2001-2005. Incidence rates are given as events per person-year. Epidemic periods were identified by statistical process-control analyses. The incidence rate of impetigo for the whole study period was 0.017 events per person-year, corresponding to a total of 334 cases. The incidence rates were 0.009, 0.026, 0.019, 0.016 and 0.009 in the years 2001, 2002, 2003, 2004 and 2005, respectively. Three epidemics were identified, starting in August of 2002, 2003 and 2004, lasting for 11, 11 and 5 weeks, respectively. Incidence rates in these epidemic periods were 0.099, 0.045 and 0.074, respectively. In epidemic periods, Staphylococcus aureus was the causal bacterium in 89% (117/132) of cases, while this proportion was 68% (84/123) in nonepidemic periods (P < 0.01). Staphylococcus aureus was resistant to fusidic acid in 84% (98/117) and 64% (54/84) of impetigo cases in epidemic and nonepidemic periods, respectively (P < 0.01). When investigating all types of infections caused by S. aureus in the study period, the proportion of fusidic acid resistance in impetigo cases (152/201, 76%) differed significantly from fusidic acid resistance in other infections (18/116, 16%) (P < 0.01). Distinctive epidemic outbreaks occurred during the summer of three of the five follow-up years. In outbreaks, S. aureus was more frequently the causal agent and the sensitivity to fusidic acid decreased significantly.

Seasonal occurrence of impetigo: a retrospective 8-year review (1996-2003)

Impetigo, a common skin infection, has shown seasonal variation in African, Australian and Indian studies. We investigated seasonal variation of impetigo in a UK paediatric population. A total of 1552 children with impetigo were seen in the Accident and Emergency (A&E) department between 1996 and 2003. The number of impetigo cases was always higher in late summer than in winter, and furthermore, increased year on year. These changes could not be accounted for by variation in total patient numbers seen in A&E, and suggest a correlation between impetigo frequency and climatic temperature. Possible reasons for these findings include exposed skin due to loose clothing in the summer leading to more skin-to-skin contact and minor trauma.

Bacterial Diseases of the Skin

When considering common bacterial diseases of the skin, rather distinct clinical responses to a variety of bacterial infections have been identified. In these cases, it is the specific site of infection and the attendant inflammatory responses that provide the characteristic clinical picture. When the pyoderma extends just below the stratum corneum, it is called impetigo. Nonbullous impetigo is the most common pediatric skin infection. It usually starts in a traumatized area. The typical lesion begins as an erythematous papule, after which it becomes a unilocular vesicle. When the subcorneal vesicle becomes pustular, it ruptures and eventually becomes a yellow, golden crust that is a hallmark of the disease process. Bullous impetigo is a less common form of impetigo, accounting for fewer than 30% of all impetigo cases. It occurs in infants and is characterized by rapid progression of vesicles to the formation of bullae measuring larger than 5 mm in diameter in previously untraumatized skin. Treatment of nonbullous impetigo must include intervention against the pathogen as well as improvements in the hygiene and living conditions of the patient. A fundamental tenet is to debride the crust (scab) from the wound surface using poloxamer 188. If the lesions are not widespread, topical mupirocin is the treatment of choice. Treatment of bullous impetigo is similar, except that the local cleansing and topical antibiotic must be complemented by systemic antibiotics if there is evidence of disseminating infections. Ecthyma is usually a consequence of failure to treat effectively impetigo. The untreated infection extends deep into the tissue in shallow ulcerations that often heal without scar. Treatment for ecthyma usually requires systemic antibiotics against either staphylococcus or streptococcus. Folliculitis is a pyoderma located within a hair follicle, secondary to follicular occlusion by keratin, overhydration, or either bacterial or fungal infection. Folliculitis may be divided into either a deep or a superficial type. In the superficial type, the pustule is located at the opening of the hair follicle. In the deep form, the infection may extend beyond the confines of the hair follicle, becoming a furuncle or boil. Carbuncles are aggregates of interconnected furuncles that drain through multiple openings of the skin. Treatment of folliculitis must include searching for and avoiding any factors predisposing to infection. If topical antibiotic therapy is ineffective in controlling the infection, surgical drainage of the infected skin abscess will be necessary. Paronychia is the most common bacterial infection of the hand, which often requires surgical incisional drainage. Similarly, a felon that is an infection of the distal pulp of a finger usually requires surgical drainage. Finally, cellulitis is an acute inflammatory reaction involving the skin and underlying subcutaneous tissue. It usually starts as erysipelas and may advance to lymphangitis, lymphadenitis, or gangrene,which will respond to life-saving interventions in the hospital that usually include systemic antibiotic treatment as well as surgical intervention.

Skin care of the newborn infant

Few care practices in infancy have shown more variability over the years than the first bath and subsequent care of the skin. Pennoyer and Sullivan reported on their experience with “dry care,” a technique practiced at the St Louis Maternity Hospital. The practice of dry care allowed the coating of vernix caseosa to remain on the skin after birth regardless of the length of hospitalization. Blood and debris were removed from the head and face in the delivery room using warm oil and any remaining vernix removed from skin creases with a moist cotton ball at 24 hours. Advocates of dry care suggested vernix acted as a kind of protective vanishing cream. This care practice was not associated with any infectious outbreak but sporadic cases of impetigo due to Staphylococcus aureus were noted, particularly in the infants of private mothers whose hospital stays were, in general, 10 days!