Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40

824 Impetigo

■Annular and crusted lesions may be seen in syphilis. Serologic tests

(RPR, etc) can be performed.

■Crusted lesions may be seen with ecthyma or varicella.

management

What to Do First

■Assess percentage of body surface area involved.

General Measures

■Gentle cleansing with soap and water at least daily

■Larger or draining lesions may be covered with an absorptive dress-

ing.

specific therapy

■Localized (<1% BSA) will usually respond to topical therapy.

■Effective topical agents include mupirocin, bacitracin, polymyxin,

erythromycin and gramicidin.

■More extensive involvement will require oral antibiotics for 7–14

days.

■Staphylococcal disease should respond to dicloxacillin or a

cephalosporin (erythromycin resistance has become common).

follow-up

■If lesions continue to spread after 24–48 hours of therapy

■If fever or lymphadenopathy continue or develop after 24–48 hours

of therapy

■If signs or symptoms of glomerulonephritis develop

complications and prognosis

Complications

■Glomerulonephritis: uncommon, but is high (12–28%) following skin

infection with a nephritogenic strain of streptococcus

■More common in children

■Patients should be watched for signs of glomerulonephritis for at

least 7 weeks after cutaneous infection clears in endemic areas for

nephritogenic M strains of streptococci

■Scarring: uncommon, best prevention is early therapeutic interven-

tion

Prognosis

■Generally excellent, with complete recovery the rule

■Recurrence because of staph nasal carriage can occur

■Glomerulonephritis a rare complication