DERMATOLOGY
TREATMENT
■ Same as SJS with burn care center admission, airway observation for pos-
sible oral mucosal sloughing, aggressive fluid rehydration, antibiotics only
when infection is present
■ Steroids are not recommended.
■ Mortality rate is 30–40% due to infection, fluid loss, and electrolyte disturbances.
IMPETIGODivided into two clinical types:
- Impetigo contagiosa
■ Caused by Staphylococcus aureusand group A streptococci
■ Superficial vesicles and pustules covered with honey colored crusts
(see Figure 17.3) - Bullous impetigo
■ Caused by epidermolytic, toxin-producing S. aureus
■ Flaccid vesicles and bullae up to 3 cm in diameter
SYMPTOMS/EXAM
■ Superficial bacterial infection of the epidermis commonly around the
nose and mouth of children <6 years old
■ Predisposing factors include poor hygiene, warm weather, overcrowding,
and breaks in skin barrier from abrasions or insect bites.
TREATMENT
■ Systemic and topical antibiotics are equally successful, with systemic pre-
ferred for more extensive infections. Neither treatment prevents the rare
development of acute glomerulonephritis.
■ Topical mupirocin 2% ointment
■ Systemic treatment: Previously treated with cephalexin, oxacillin. Due to
prevalence of CA-MRSA, current recommendations are for TMP-SMZ or
clindamycin.
■ Meticulous hygiene can prevent the spread.
FIGURE 17.2. Impetigo.
(Courtesy of Michael J. Nowicki, MD as reproduced, with permission, from Knoop KJ, Stack LB,
Storrow AB.Atlas of Emergency Medicine, 2nd ed. New York: McGraw-Hill, 2002:444.)