Approaches to Disease Management: Dermatologic Disorder
Discuss Impetigo in pediatrics, a dermatologic disorder, and its treatment modalities.
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Approaches to Disease Management: Dermatologic Disorder – Impetigo in Pediatrics
Impetigo is a common superficial bacterial skin infection predominantly affecting the pediatric population, especially children aged 2 to 5 years. It is characterized by vesicular and pustular lesions that often rupture and develop honey-colored crusts. Impetigo is highly contagious and typically spreads through close contact, sharing personal items, or through autoinoculation from pre-existing skin conditions such as eczema, insect bites, or abrasions (Paller & Mancini, 2021). There are two main clinical forms: non-bullous impetigo (the most common) and bullous impetigo, which is caused by exfoliative toxin-producing strains of Staphylococcus aureus.
Etiology and Risk Factors
Impetigo is primarily caused by Staphylococcus aureus and Streptococcus pyogenes. The increasing prevalence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has impacted treatment decisions in recent years (Hoeger et al., 2020). Risk factors include poor hygiene, warm and humid climates, crowded living conditions, and participation in contact sports. Children attending daycare or school are particularly at risk due to the close physical contact and the likelihood of minor skin injuries.
Clinical Presentation
Non-bullous impetigo begins as small vesicles or pustules that rupture and form characteristic golden-yellow crusts on erythematous bases. Lesions commonly occur on the face, particularly around the nose and mouth, but can spread to other areas. Bullous impetigo presents as larger fluid-filled blisters caused by S. aureus toxins, which rupture and leave superficial erosions. Constitutional symptoms are usually mild but may include low-grade fever and lymphadenopathy.
Diagnosis
Diagnosis is primarily clinical, based on the appearance and distribution of the lesions. However, bacterial cultures may be indicated in cases where initial treatment fails, in recurrent episodes, or when MRSA is suspected. Cultures help guide antibiotic selection and are especially important in outbreaks or healthcare settings.
Treatment Modalities
Management of impetigo includes both pharmacologic and non-pharmacologic interventions. Treatment choice depends on the severity, extent of lesions, and presence of systemic symptoms.
Topical Antibiotics
For localized non-bullous impetigo, topical antibiotics are the first-line treatment. Mupirocin 2% ointment applied three times daily for 5–7 days is effective against both S. aureus and S. pyogenes (Stevens et al., 2014). Retapamulin, another topical agent, may also be used but is limited by availability and resistance concerns.
Oral Antibiotics
Oral antibiotics are indicated for widespread lesions, bullous impetigo, or in cases with systemic symptoms. First-line oral options include cephalexin, dicloxacillin, or amoxicillin-clavulanate. In areas with high prevalence of MRSA or if MRSA is suspected, clindamycin, trimethoprim-sulfamethoxazole, or doxycycline (for children over 8 years) may be considered (Hoeger et al., 2020).
Supportive Measures and Prevention
Supportive care includes gentle cleansing of the affected areas with soap and water to remove crusts. Children should be kept home from school or daycare until 24 hours after initiating antibiotics to reduce transmission. Personal hygiene education and avoidance of sharing personal items are critical for preventing recurrence.
Conclusion
Impetigo remains a significant pediatric dermatologic condition due to its contagious nature and potential for complications such as post-streptococcal glomerulonephritis. Early recognition and appropriate treatment with topical or oral antibiotics lead to rapid resolution and limit spread. Ongoing surveillance for MRSA and antibiotic resistance patterns is vital in guiding empirical treatment. Preventive strategies, including hygiene promotion and early intervention, are key components in the management of impetigo in children.
References
Hoeger, P. H., Antaya, R. J., Spraker, M., & McGuire, E. (2020). Pediatric dermatology (5th ed.). Elsevier.
Paller, A. S., & Mancini, A. J. (2021). Hurwitz clinical pediatric dermatology: A textbook of skin disorders of childhood and adolescence (6th ed.). Elsevier.
Stevens, D. L., Bisno, A. L., Chambers, H. F., Dellinger, E. P., Goldstein, E. J. C., Gorbach, S. L., … & Wade, J. C. (2014). Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 59(2), e10-e52. https://doi.org/10.1093/cid/ciu296
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