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Rodríguez Sánchez B, Martín-Nieto González J, García Piqueras P, Campos Domínguez M. Vulvar Erosions in a Child: A Case of Vulvar Impetigo. Pediatr Infect Dis J 2024; 43:e119-e120. [PMID: 38063507 DOI: 10.1097/inf.0000000000004204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- Belen Rodríguez Sánchez
- Department of Dermatology and Venereology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Wan Y, Zhang L, Xie B, Wu J, Zhao M, Guo J, Ding J. Impetigo herpetiformis in the second trimester: a case report and review of the literature. J Int Med Res 2023; 51:3000605231217950. [PMID: 38102997 PMCID: PMC10725655 DOI: 10.1177/03000605231217950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
Impetigo herpetiformis is a rare skin disease that most often occurs in the third trimester of pregnancy. It is currently considered as a form of generalized pustular psoriasis and the typical skin lesions comprise small sterile pustules. Here, a case of impetigo herpetiformis in the second trimester of pregnancy after 7 weeks of hydroxychloroquine administration for suspected Sjogren's syndrome is reported. Treatment with anti-infective, anti-inflammatory and immunosuppressive medication did not improve the patient's condition. Following delivery of a live male by emergency caesarean section at 29 weeks' gestation, the rash was reported to be completely resolved by 3 months postpartum. Previously published cases of impetigo herpetiformis in the second trimester of pregnancy that were retrieved from a search of the PubMed database are also reviewed and discussed.
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Affiliation(s)
- Yingcai Wan
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Lei Zhang
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Boyu Xie
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jianbo Wu
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Mengjie Zhao
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Juanjuan Guo
- Department of Obstetrics and Gynaecology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Juan Ding
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
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Thornley S, Sundborn G, Engelman D, Roskvist R, Pasay C, Marshall R, Long W, Dugu N, Hopoi N, Moritsuka S, McCarthy J, Morris AJ. Children's scabies survey indicates high prevalence and misdiagnosis in Auckland educational institutions. J Paediatr Child Health 2023; 59:1296-1303. [PMID: 37920140 DOI: 10.1111/jpc.16512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
AIM Here, we present results of a survey of scabies prevalence in childcare centres and primary schools in Auckland. METHODS Children whose parents agreed to take part in participating centres in the Auckland region were examined for scabies by general practitioners and given questionnaires of relevant symptoms. Diagnoses of clinical or suspected scabies were made according to the International Alliance for the Control of Scabies (IACS) criteria. The survey was a stratified random sample of schools and early childcare centres. A quantitative polymerase chain reaction (PCR) test was also used to complement the IACS criteria. RESULTS A total of 181 children were examined, with 145 children with history information, 16 of whom (11.0%) met the criteria for 'clinical' or 'suspected' scabies. Weighted analysis, accounting for the survey design, indicated that the prevalence of scabies in early childcare centres was 13.2% (95% CI: 4.3 to 22.1), with no school-aged children fulfilling these criteria. A higher proportion had clinical signs of scabies with 23 (12.7%) having typical scabies lesions and a further 43 (23.8%) had atypical lesions. A total of 64 PCR tests were taken and 15 (23%) were positive. None of these cases were receiving treatment for scabies. Five were undergoing topical skin treatment: three with topical steroid and two with calamine lotion. CONCLUSIONS The prevalence of children with scabies is high in early childcare centres in Auckland. Misdiagnosis is suggested by several PCR positive cases being treated by topical agents used to treat other skin conditions.
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Affiliation(s)
- Simon Thornley
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Daniel Engelman
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rachel Roskvist
- Department of Primary Care, The University of Auckland, Auckland, New Zealand
| | - Cielo Pasay
- QIMR Berghoffer Medical Research Institute, Brisbane, Queensland, Australia
| | - Roger Marshall
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Wei Long
- Auckland Family Medical Centre, Auckland, New Zealand
| | - Noela Dugu
- Conifer Gardens Medical Centre, Auckland, New Zealand
| | | | - Shunsuke Moritsuka
- Section of Pacific Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - James McCarthy
- Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Arthur J Morris
- LabPLUS, Auckland District Health Board, Auckland, New Zealand
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Gatto A, Capossela L, Ferretti S, Di Sarno L, Oliveti A, Talamonti D, Curatola A, Chiaretti A, Fiori B. Single-center, prospective, and observational study on the management and treatment of impetigo in a pediatric population. Eur Rev Med Pharmacol Sci 2023; 27:9273-9278. [PMID: 37843341 DOI: 10.26355/eurrev_202310_33955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Ozenoxacin is a new antibiotic used to treat non-bullous impetigo. The aim of this study is to evaluate the microbiological and clinical efficacy of topical ozenoxacin 1% cream after 5-day twice-daily treatment, in pediatric patients with impetigo. PATIENTS AND METHODS This observational and prospective study included patients aged 6 months to 18 years, with non-bullous impetigo. Efficacy was measured using the Skin Infection Rating Scale (SIRS) and microbiological culture at the first visit (T0), at the second visit after 72 hours (T1) and after 5 days (T2). Safety and tolerability were also evaluated. RESULTS A total of 50 patients was enrolled. A reduction of SIRS score >10% after 72 hours of treatment was noticed in all patients, while a complete reduction was assessed after 5 days in all the population. Microbiologic success rates for ozenoxacin at T1 was 92% (four patients had original pathogens in the specimen culture from the skin area), whereas at T2, it was 100%. CONCLUSIONS Topical ozenoxacin has strong efficacy in treating impetigo in pediatric patients. Ozenoxacin's clinical and microbiological rapid onset of response led to consider this antibiotic a novel efficacy option for the treatment of impetigo.
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Affiliation(s)
- A Gatto
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
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5
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Young PA, Leeolou MC, Narala S, Saleem A, Bae GH. Bullous impetigo on a young man's abdomen. Dermatol Online J 2023; 29. [PMID: 37040917 DOI: 10.5070/d329160220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023] Open
Abstract
Bullous impetigo is a variant of epidermal infection by Staphylococcus aureus, representing 30% of impetigo cases. Its clinical appearance may mimic certain autoimmune blistering dermatoses and other cutaneous infections, sometimes necessitating careful evaluation. Herein we present a patient with bullous impetigo in a striking and characteristic appearance and briefly overview the approach to diagnosis, treatment, and prevention.
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Affiliation(s)
- Peter A Young
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA Department of Dermatology, The Permanente Medical Group, Sacramento, California, USA
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6
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Xie F, Johnson EF, Cantwell HM. Disseminated Bullous Impetigo in an Adult With Atopic Dermatitis Flare. Mayo Clin Proc 2022; 97:2097-2098. [PMID: 36333016 DOI: 10.1016/j.mayocp.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Khan RMA, Muzammil A, Siddiqi S, Qasim SM, Nadeem A. Scabies Surrepticius (Bullous Scabies) Presenting as Bullous Impetigo in a Child. J Coll Physicians Surg Pak 2022; 32:380-382. [PMID: 35148595 DOI: 10.29271/jcpsp.2022.03.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/02/2020] [Indexed: 06/14/2023]
Abstract
Bullous scabies (BS) is a rare and atypical presentation of scabies, usually affecting elderly males during the seventh decade of life. BS is characterised by intense pruritic eruptions, nocturnal itch, and characteristic blisters with or without burrows in scabies-prone areas. The scabies lesions might predispose patients to bacterial super-infections, resulting in bullae formation similar to bullous impetigo. The diagnosis of BS is often puzzling and delayed. Few cases of BS have been reported among children globally. We, herein, report a case of BS in an eight-year boy from Pakistan, treated successfully with 5% topical permethrin and 2% mupirocin. Complete healing was noted within four weeks with no recurrence at two months follow-up. Key Words: Scabies, Bullous, Child, Diagnosis, Treatment.
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Affiliation(s)
- Rao Muhammad Abid Khan
- Department of Microbiology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Asma Muzammil
- Department of Dermatology, Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan
| | - Sualleha Siddiqi
- Department of Microbiology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Shazia Muhammad Qasim
- Department of Molecular Biology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Ali Nadeem
- Department of Microbiology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
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Chamli A, Zaouak A, Hammami H. Genital Bullous Impetigo in a Child. Indian Pediatr 2021; 58:1104. [PMID: 34837377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Amal Chamli
- Dermatology Department, Habib Thameur Hospital, Tunis, Tunisia and University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia.
| | - Anissa Zaouak
- Dermatology Department, Habib Thameur Hospital, Tunis, Tunisia and University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Houda Hammami
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia and Habib Thameur Hospital, Research Unit 'Genodermatoses and Cancers' LR12SP03
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Brazel M, Desai A, Are A, Motaparthi K. Staphylococcal Scalded Skin Syndrome and Bullous Impetigo. Medicina (Kaunas) 2021; 57:medicina57111157. [PMID: 34833375 PMCID: PMC8623226 DOI: 10.3390/medicina57111157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/21/2022]
Abstract
Staphylococcal scalded skin syndrome (SSSS) and bullous impetigo are infections caused by Staphylococcus aureus. The pathogenesis of both conditions centers around exotoxin mediated cleavage of desmoglein-1, which results in intraepidermal desquamation. Bullous impetigo is due to the local release of these toxins and thus, often presents with localized skin findings, whereas SSSS is from the systemic spread of these toxins, resulting in a more generalized rash and severe presentation. Both conditions are treated with antibiotics that target S. aureus. These conditions can sometimes be confused with other conditions that result in superficial blistering; the distinguishing features are outlined below.
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Affiliation(s)
- Morgan Brazel
- University of Florida College of Medicine, Gainesville, FL 32610, USA; (M.B.); (A.A.)
| | - Anand Desai
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL 32610, USA;
| | - Abhirup Are
- University of Florida College of Medicine, Gainesville, FL 32610, USA; (M.B.); (A.A.)
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL 32610, USA;
- Correspondence:
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Abstract
This evidence-based review highlights cutaneous infections of bacterial, viral, and fungal origin that are frequently encountered by clinicians in all fields of practice. With a focus on treatment options and management, the scope of this article is to serve as a reference for physicians, regardless of field of specialty, as they encounter these pathogens in clinical practice.
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Affiliation(s)
- Ana Preda-Naumescu
- School of Medicine, University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL 35233, USA
| | - Boni Elewski
- Department of Dermatology, University of Alabama at Birmingham, 510 20th Street South, FOT Suite 858, Birmingham, AL 35233, USA
| | - Tiffany T Mayo
- Department of Dermatology, University of Alabama at Birmingham, 510 20th Street South, FOT Suite 858, Birmingham, AL 35233, USA.
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Lake SJ, Engelman D, Sokana O, Nasi T, Boara D, Grobler AC, Osti MH, Andrews R, Marks M, Whitfeld MJ, Romani L, Kaldor JM, Steer AC. Defining the need for public health control of scabies in Solomon Islands. PLoS Negl Trop Dis 2021; 15:e0009142. [PMID: 33617544 PMCID: PMC7932527 DOI: 10.1371/journal.pntd.0009142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/04/2021] [Accepted: 01/14/2021] [Indexed: 01/22/2023] Open
Abstract
Pacific Island countries have a high burden of scabies and impetigo. Understanding of the epidemiology of these diseases is needed to target public health interventions such as mass drug administration (MDA). The aim of this study is to determine the prevalence of scabies and impetigo in Solomon Islands as well as the relationship between them and their distribution. We conducted a prevalence study in 20 villages in Western Province in Solomon Islands. All residents of the village were eligible to participate. Nurses conducted clinical assessments including history features and skin examination. Diagnosis of scabies was made using the 2020 International Alliance for the Control of Scabies diagnostic criteria. Assessments were completed on 5239 participants across 20 villages. Overall scabies prevalence was 15.0% (95%CI 11.8-19.1). There was considerable variation by village with a range of 3.3% to 42.6%. There was a higher prevalence of scabies in males (16.7%) than females (13.5%, adjusted relative risk 1.2, 95%CI 1.1-1.4). Children aged under two years had the highest prevalence (27%). Overall impetigo prevalence was 5.6% (95%CI 4.2-7.3), ranging from 1.4% to 19% by village. The population attributable risk of impetigo associated with scabies was 16.1% (95% CI 9.8-22.4). The prevalence of scabies in our study is comparable to previous studies in Solomon Islands, highlighting a persistent high burden of disease in the country, and the need for public health strategies for disease control.
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Affiliation(s)
- Susanna J. Lake
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne Children’s Global Health, Melbourne, Australia
| | - Daniel Engelman
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne Children’s Global Health, Melbourne, Australia
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara Solomon Islands
| | - Titus Nasi
- Ministry of Health and Medical Services, Honiara Solomon Islands
| | - Dickson Boara
- Ministry of Health and Medical Services, Honiara Solomon Islands
| | - Anneke C. Grobler
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Millicent H. Osti
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Ross Andrews
- Australian National University, Canberra, Australia
| | - Michael Marks
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, London, United Kingdom
| | | | - Lucia Romani
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - John M. Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew C. Steer
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne Children’s Global Health, Melbourne, Australia
- * E-mail:
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Schachner LA, Andriessen A, Benjamin LT, Claro C, Eichenfield LF, Esposito SM, Keller L, Kircik L, Kwong PC, McCuaig C. Do Antimicrobial Resistance Patterns Matter? An Algorithm for the Treatment of Patients With Impetigo. J Drugs Dermatol 2021; 20:134-142. [PMID: 33538559 DOI: 10.36849/jdd.5745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Impetigo, a highly contagious bacterial skin infection commonly occurring in young children, but adults may also be affected. The superficial skin infection is mainly caused by Staphylococcus aureus (S. aureus) and less frequently by Streptococcus pyogenes (S. pyogenes). Antimicrobial resistance has become a worldwide concern and needs to be addressed when selecting treatment for impetigo patients. An evidence-based impetigo treatment algorithm was developed to address the treatment of impetigo for pediatric and adult populations. METHODS An international panel of pediatric dermatologists, dermatologists, pediatricians, and pediatric infectious disease specialists employed a modified Delphi technique to develop the impetigo treatment algorithm. Treatment recommendations were evidence-based, taking into account antimicrobial stewardship and the increasing resistance to oral and topical antibiotics. RESULTS The algorithm includes education and prevention of impetigo, diagnosis and classification, treatment measures, and follow-up and distinguishes between localized and widespread or epidemic outbreaks of impetigo. The panel adopted the definition of localized impetigo of fewer than ten lesions and smaller than 36 cm2 area affected in patients of two months and up with no compromised immune status. Resistance to oral and topical antibiotics prescribed for the treatment of impetigo such as mupirocin, retapamulin, fusidic acid, have been widely reported. CONCLUSIONS When prescribing antibiotics, it is essential to know the local trends in antibiotic resistance. Ozenoxacin cream 1% is highly effective against S. pyogenes and S. aureus, including methycyllin-susceptible and resistant strains (MRSA), and may be a suitable option for localized impetigo.J Drugs Dermatol. 2021;20(2):134-142. doi:10.36849/JDD.5475
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Connelly W, Daze R, Mammino J, Zambrano R. Facial Rash with Oral Lesions. Am Fam Physician 2020; 102:243-244. [PMID: 32803933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | | | - Jason Mammino
- Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Program, Orlando, FL, USA
| | - Regina Zambrano
- Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, USA
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Robinson SK, Jefferson IS, Agidi A, Moy L, Lake E, Kim W. Pediatric dermatology emergencies. Cutis 2020; 105:132-136. [PMID: 32352437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Many pediatric skin conditions can be safely monitored with minimal intervention, but certain skin conditions are emergent and require immediate attention and proper assessment of the neonate, infant, or child. We review the following pediatric dermatology emergencies so that clinicians can detect and accurately diagnose these conditions to avoid delayed treatment and considerable morbidity and mortality if missed: staphylococcal scalded skin syndrome (SSSS), impetigo, eczema herpeticum (EH), Langerhans cell histiocytosis (LCH), infantile hemangioma (IH), and IgA vasculitis.
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Affiliation(s)
- S Kayo Robinson
- Division of Dermatology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Itisha S Jefferson
- Division of Dermatology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Ada Agidi
- Division of Dermatology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Lauren Moy
- Division of Dermatology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Eden Lake
- Division of Dermatology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Wendy Kim
- Division of Dermatology, Loyola University Medical Center, Maywood, Illinois, USA
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Osti MH, Sokana O, Gorae C, Whitfeld MJ, Steer AC, Engelman D. The diagnosis of scabies by non-expert examiners: A study of diagnostic accuracy. PLoS Negl Trop Dis 2019; 13:e0007635. [PMID: 31425513 PMCID: PMC6715246 DOI: 10.1371/journal.pntd.0007635] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/29/2019] [Accepted: 07/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background Although scabies is estimated to be one of the most common skin conditions globally, prevalence data is not available in most settings. Disease mapping is required to develop and monitor successful control programs. Non-expert health workers are likely to play an important role in scabies mapping activities in endemic settings. Methodology Four non-expert health workers were trained in the diagnosis of scabies and impetigo. The health worker diagnosis was compared to a reference consensus diagnosis of two doctors experienced in diagnosis. The study was conducted in a primary school in Gizo, Solomon Islands, in August 2018. The six examiners consecutively assessed school students, blinded to each other’s findings. Training and diagnostic procedures followed criteria for scabies diagnosis established by the International Alliance for the Control of Scabies in 2018. Principal findings Amongst the 171 students who underwent clinical assessment the prevalence of scabies and impetigo according to the reference standard was 55% and 45% respectively. Sensitivity of the non-expert health workers’ diagnosis compared to the reference standard was 55.3% for scabies (95% confidence interval [CI], 50.1–60.4) with a specificity of 89.9% (95% CI 86–93.1) and 52.6% for impetigo (95% CI 46.9–58.3) with a specificity 97.8% (95% CI 95.7–99). Sensitivity for moderate to severe scabies was 93.5% (95% CI 86.3–97.6) with a specificity of 74% (95% CI 70.2–77.5). Conclusions Following brief training, the diagnostic accuracy of non-expert health workers for scabies and impetigo was promising, especially for moderate to severe disease. Modifications to training and processes are recommended to further improve accuracy. The diagnosis by non-expert health workers may be acceptable for scabies and impetigo mapping in endemic areas. Scabies is a parasitic infection that leads to significant morbidity worldwide. Mapping of scabies prevalence would improve the understanding of the true burden of disease and the need for control programs in specific countries and regions. The diagnosis of scabies in low resource settings, where the disease is most prevalent, is reliant on clinical examination. A task shifting approach, utilizing local health staff, could substantially increase the feasibility to undertake mapping surveys in low-resource settings. In this study, we aimed to evaluate the diagnostic accuracy of clinical assessment of local health workers following brief training. Our study found that these non-expert health workers could diagnose scabies with moderate accuracy and diagnose more severe disease with high accuracy. Further work is needed to develop standardized training packages to ensure a high level of diagnostic accuracy by non-expert health workers.
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Affiliation(s)
- Millicent H. Osti
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Children’s Global Health, Melbourne, VIC, Australia
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Christina Gorae
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Margot J. Whitfeld
- Department of Dermatology, St Vincent’s Hospital, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Andrew C. Steer
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Children’s Global Health, Melbourne, VIC, Australia
- Department of General Medicine, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Daniel Engelman
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Children’s Global Health, Melbourne, VIC, Australia
- Department of General Medicine, Royal Children’s Hospital, Melbourne, VIC, Australia
- * E-mail:
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Schlager E, Ashack K, Khachemoune A. Erosio interdigitalis blastomycetica: A review of interdigital candidiasis. Dermatol Online J 2018; 24:13030/qt8tm443f6. [PMID: 30677843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 06/09/2023] Open
Abstract
Erosio interdigitalis blastomycetica (EIB) is a Candida infection affecting the third web space, between the third and fourth fingers. In 1915, Gougerot and Goncea first described saccharomycetic organisms isolated from the hands and feet. Johannes Fabry later named it in 1917, well before the genus Candida was introduced in 1923. EIB is most common among those who work with their hands frequently in water, such as dishwashers, launderers, bartenders, and homemakers. Clinical presentation most commonly consists of a central erythematous erosion surrounded by a rim of white macerated skin involving at least one interdigital web space. The differential diagnosis is narrow, consisting of irritant contact dermatitis (ICD), erythrasma, inverse psoriasis, and bacterial infection (i.e. impetigo). The diagnosis is made by clinical examination in addition to fungal culture and KOH testing. The prognosis is good and treatment options include avoidance of frequent water immersion and topical or oral antifungal agents. Suspicion for secondary infections such as erysipelas and cellulitis should remain high until lesions have resolved. This review aims to address the history, epidemiology, pathophysiology, histopathology, clinical presentation, differential diagnoses, diagnosis, prognosis, and management of EIB. It also suggests an alternative name in place of the current misnomer.
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Affiliation(s)
| | | | - Amor Khachemoune
- Veterans Affairs Medical Center Brooklyn, New York SUNY Downstate, Department of Dermatology, Brooklyn, New York.
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17
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Korte LM, Bowen AC, Draper ADK, Davis K, Steel A, Teodora I, Mascarenhas I, Dingle B, Francis JR. Scabies and impetigo in Timor-Leste: A school screening study in two districts. PLoS Negl Trop Dis 2018; 12:e0006400. [PMID: 29852002 PMCID: PMC5997349 DOI: 10.1371/journal.pntd.0006400] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 06/12/2018] [Accepted: 03/22/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Scabies and impetigo are common and important skin conditions which are often neglected in developing countries. Limited data have been published on the prevalence of scabies and impetigo in Timor-Leste. Sequelae including cellulitis, bacteraemia, nephritis, acute rheumatic fever and rheumatic heart disease contribute significantly to the burden of disease. METHODS School students were recruited from schools in Dili (urban) and Ermera (rural) in Timor-Leste for an epidemiological study in October 2016. A standard questionnaire was used to record demographics, anthropometry and skin examination results. Impetigo and scabies were diagnosed based on clinical examination of exposed surfaces, and clinical photographs were reviewed for correlation by an infectious diseases paediatrician. Prevalence of scabies and impetigo were calculated and binary risk factor associations were described using relative risks and 95% confidence intervals. Adjusted odds ratios were calculated using logistic regression multivariate analysis. Continuous variables were analysed for associations using the Mann-Whitney Rank Sum test. RESULTS The study enrolled 1396 students; median age 11 years (interquartile range (IQR) 9-15). The prevalence of scabies was 22.4% (95% CI 20.2-24.7%) and active impetigo 9.7% (95% CI 8.3-11.4%); 68.2% of students had evidence of either active or healed impetigo. Students in Ermera were more likely than those in Dili to have scabies (prevalence 32.0% vs 5.2%, aOR 8.1 (95% CI 5.2-12.4), p<0.01). There was no difference in the prevalence of active impetigo between urban and rural sites. More than a third of participants were moderately or severely underweight. Stunting was markedly more common in the rural district of Ermera. CONCLUSION Scabies and impetigo are common in Timor-Leste, with very high prevalence of scabies in the rural district of Ermera. Improvements in prevention and treatment are needed, with prioritised activities in the rural areas where prevalence is highest.
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Affiliation(s)
- Laura M. Korte
- Paediatric Department, Royal Darwin Hospital, Darwin, Australia
- Paediatric Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Asha C. Bowen
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- School of Paediatrics, University of Western Australia, Perth, Australia
| | - Anthony D. K. Draper
- Northern Territory Centre for Disease Control, Darwin, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Kim Davis
- Paediatric Department, Royal Darwin Hospital, Darwin, Australia
- Paediatric Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | | | - Ines Teodora
- Paediatric Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Ivonia Mascarenhas
- Paediatric Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | | | - Joshua R. Francis
- Paediatric Department, Royal Darwin Hospital, Darwin, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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18
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Chow SY. A Burning Red Rash. Am Fam Physician 2017; 96:543-544. [PMID: 29094892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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19
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Qin R, Cohen PR. Concurrent pyogenic granuloma and bullous impetigo of a pregnant woman's finger. Dermatol Online J 2017; 23:13030/qt0p22m4dg. [PMID: 28329529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/22/2017] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Bullous impetigo is a superficial skininfection caused by Staphylococcus aureus (S.aureus). Pyogenic granuloma is a common benigntumor frequently associated with prior trauma.Bullous impetigo and pyogenic granuloma may occurin pregnant women. PURPOSE The features of a pregnant womanwith pyogenic granuloma and bullous impetigoconcurrently present in a lesion on her finger aredescribed. METHODS PubMed was used to search the followingterms: bullous impetigo, pregnancy, and pyogenicgranuloma. All papers were reviewed; relevantarticles, along with their references, were evaluatedResults: A red ulcerated nodule with a collaretteof epithelium around the tumor and surroundingbullae appeared on the fifth digit of the left hand of a31-year-old woman who was at 36 weeks gestation. Abacterial culture grew methicillin sensitive S. aureus.An excisional biopsy was performed. Histologicfindings revealed not only a benign vascular tumorwith an infiltrate of mixed inflammatory cells, butalso an intraepidermal blister. She received oralantibiotics and there was complete resolution of thefinger lesion and infection with preservation of digitfunction. CONCLUSION Albeit uncommon, pyogenic granulomaand bullous impetigo may concurrently occur in thesame lesion. Therapeutic intervention should focuson treating both the benign skin tumor and theinfection.
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Affiliation(s)
- Rosie Qin
- Department of Medicine, University of California San Diego, La Jolla, California.
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Saito-Sasaki N, Izu K, Sawada Y, Hino R, Nakano R, Shimajiri S, Nishimura I, Nakamura H, Sugiura K, Nakamura M. Impetigo Herpetiformis Complicated with Intrauterine Growth Restriction Treated Successfully with Granulocyte and Monocyte Apheresis. Acta Derm Venereol 2017; 97:410-411. [PMID: 27573023 DOI: 10.2340/00015555-2527] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Natsuko Saito-Sasaki
- Department of Dermatology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu , 807-8555, Japan.
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21
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Abstract
Impetigo, a bacterial skin infection that involves the superficial layers of the skin, is one of the most common skin infections in children ages 2 to 5 but can occur in individuals across the lifespan. This article discusses the diagnosis and management of impetigo in primary care.
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Affiliation(s)
- Kathy VanRavenstein
- Kathy VanRavenstein is an instructor at the Medical University of South Carolina, College of Nursing, Charleston, S.C. Whitney Smith is an instructor at the Medical University of South Carolina, College of Nursing, Charleston, S.C. Catherine O'Connor Durham is an assistant professor at the Medical University of South Carolina, College of Nursing, Charleston, S.C. Tiffany H. Williams is an assistant professor at the Medical University of South Carolina, College of Nursing, Charleston, S.C
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22
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Gupta AK, Versteeg SG, Abramovits W. Ozenoxacin Cream, 1% - Topical Treatment of Impetigo. Skinmed 2017; 15:57-59. [PMID: 28270312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Aditya K Gupta
- Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada, Dallas, TX;
- Mediprobe Research Inc., London, Ontario, Canada, Dallas, TX
| | | | - William Abramovits
- Department of Medicine, Baylor University Medical Center, Dallas, TX
- Departments of Dermatology and Family Practice, University of Texas Southwestern Medical School, Dallas, TX
- Dermatology Treatment and Research Center, Dallas, TX
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Molinelli E, Ricotti F, Campanati A, Cataldi I, Ganzetti G, Liberati G, Bianchelli T, Offidani A. Kaposi-Juliusberg varicelliform eruption in patients suffering from Darier-White Disease: a case report and review of the literature. GIORN ITAL DERMAT V 2016; 151:558-561. [PMID: 25502366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Darier-White Disease (DW), otherwise known as keratosis follicularis, is a rare genodermatosis with autosomal dominant inheritance, characterized by loss of adhesion between epidermal cells and abnormal keratinization. The distinctives lesions of DW Disease include rough papules in seborrheic areas, palmoplantar pits, mucosal involvement, and nail changes. DW Disease can be occasionally associated with bacterial complications, but rarely with viral ones. Kaposi's varicelliform eruption (KVE) is a secondary herpes simplex virus infection that affects patients in the setting of primary dermatologic conditions. KVE, frequently misdiagnosed as impetigo, can be severe, progressing to disseminated infections and potentially life threatening. It occurs with a variety of skin disorders, although association with DW Disease has rarely been reported in the literature. This report describes a case of KVE in a patient suffering from DW Disease, focusing on its clinical course. A review of the literature on KVE including disease associations, pathogenesis, and treatment has been also reported.
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Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytehnic Marche University, Ancona, Italy -
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Chamny S, Miron D, Lumelsky N, Shalev H, Gazal E, Keynan R, Shemer A, Tamarkin D. Topical Minocycline Foam for the Treatment of Impetigo in Children: Results of a Randomized, Double-Blind, Phase 2 Study. J Drugs Dermatol 2016; 15:1238-1243. [PMID: 27741342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Currently available treatment options for impetigo are limited by either systemic side effects (for oral therapy) or lack of ease of use (for topical ointment). A novel foam formulation of minocycline for topical use may improve convenience and treatment utilization for pediatric patients with impetigo. OBJECTIVE To evaluate the safety and efficacy of topically applied minocycline foam (FMX-102 1% and 4%) in the treatment of impetigo and to determine the optimal therapeutic active ingredient concentration. METHODS In this randomized, parallel-group, double-blind, comparative clinical trial, 32 subjects aged ≥2 years with a clinical diagnosis of pure impetigo, impetigo contagiosa, or uncomplicated blistering impetigo were randomized to treatment with FMX-102 1% or 4%, twice daily for 7 days. Subjects were followed for up to 7 days post-treatment. RESULTS Clinical cure, defined as ≥80% cured lesions (fully recovered lesions, visually determined by investigators), was achieved by 57.1% and 50.0% of FMX-102 1% and 4% subjects, respectively, at the end of treatment (visit 3). Clinical success, defined as the absence of lesions, or the drying or improvement of treated lesions (decrease in size of affected area, lesion number, or both), was demonstrated in 81.3% and 78.6% of FMX-102 1% and 4% subjects, respectively, following 3 days of treatment (visit 2), in 92.3% and 100% of the respective subjects at the end of treatment, and in 100% in both groups at follow-up (visit 4). Bacteriologic success rates at the end of treatment, defined as complete pathogen eradication, were 85% and 74% in the FMX-102 1% and 4% groups, respectively. The bacteriologic success rate for MRSA infections was 100% (11/11), with no recurrences. Both FMX-102 1% and 4% were considered well tolerated and safe. CONCLUSION Topical minocycline foam may be a safe and effective new treatment option for impetigo in children, including those with MRSA. <br /><br /> <em>J Drugs Dermatol.</em> 2016;15(10):1238-1243.
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Cohen PR. Bullous impetigo and pregnancy: Case report and review of blistering conditions in pregnancy. Dermatol Online J 2016; 22:13030/qt7533z2m0. [PMID: 27617460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Bullous impetigo results from Staphylococcus aureus (S. aureus) release of exfoliative toxins type A and type B thatresults in flaccid, easily ruptured, bullae in the upper layers of the epidermis. Physiologic, gestation-associated, and incidental skin changes can occur in pregnancy. Blisters in pregnant women can occur secondary to either common skin disorders orspecific dermatoses of pregnancy. PURPOSE To describe a pregnant woman with bullous impetigo and review bullous conditions in pregnant women. METHODS PubMed was used to search the following terms, separately and in combination: blister, blistering, bullous, gestationis, herpes, herpetiformis, impetigo, pemphigoid, pregnancy, pregnant, psoriasis, pustular, virus. All papers were reviewed and relevant manuscripts, along with their reference citations, were evaluated. RESULTS Flaccid, easily rupturing, pustules, which developed into superficial annular erosions with peripheral scale and central healing appeared in a woman of 7-weeks gestation and allergy to penicillin on her lower abdomen, suprapubic region, perineum, buttocks, and proximal legs. A bacterial culture subsequently isolated methicillin-susceptible S. aureus. All of the lesions resolved after treatment with clindamycin. CONCLUSIONS Bullous impetigo should be considered in the differential diagnosis of common skin diseases presenting as blistersin pregnant women.
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Affiliation(s)
- Philip R Cohen
- Department of Dermatology, University of California San Diego.
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26
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Molenaar-Hoogendijk M, Boute FJ, Loots MAM. [A neonate with blisters on his upper legs]. Ned Tijdschr Geneeskd 2016; 160:A9666. [PMID: 26860750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 10-days-old male neonate presented with multiple bullae, mostly in the diaper region, without signs of illness. We diagnosed this condition as neonatal bullous impetigo and treated the patient orally with flucloxacillin. Bullous impetigo is caused by Staphylococcus aureus toxins that break down intercellular proteins.
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27
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Ramon C. [Why is the exanthema so extremely painful? Impetigo contagiosa]. MMW Fortschr Med 2015; 157:5. [PMID: 26012650 DOI: 10.1007/s15006-015-2994-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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28
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Bansal P, Adebambo B. Blisters over the buttocks. Am Fam Physician 2015; 91:323-324. [PMID: 25822389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Purnima Bansal
- Greater Lawrence Family Health Center, Lawrence, MA, USA
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29
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Hundscheid T, Schott DA, Vissers-Croughs KJM. [An infant with a suspicious lesion on her abdomen]. Ned Tijdschr Geneeskd 2015; 159:A8557. [PMID: 25873220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A six-month-old female girl presented with a lesion on her right hemi-abdomen. The lesion occurred after she visited her father, who just came out of prison. Therefore, child abuse was suspected. A skin culture showed Staphylococcus aureus. The diagnosis was 'impetigo vulgaris'. Treatment with local antibiotics was successful.
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30
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Hartman-Adams H, Banvard C, Juckett G. Impetigo: diagnosis and treatment. Am Fam Physician 2014; 90:229-235. [PMID: 25250996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Impetigo is the most common bacterial skin infection in children two to five years of age. There are two principal types: nonbullous (70% of cases) and bullous (30% of cases). Nonbullous impetigo, or impetigo contagiosa, is caused by Staphylococcus aureus or Streptococcus pyogenes, and is characterized by honey-colored crusts on the face and extremities. Impetigo primarily affects the skin or secondarily infects insect bites, eczema, or herpetic lesions. Bullous impetigo, which is caused exclusively by S. aureus, results in large, flaccid bullae and is more likely to affect intertriginous areas. Both types usually resolve within two to three weeks without scarring, and complications are rare, with the most serious being poststreptococcal glomerulonephritis. Treatment includes topical antibiotics such as mupirocin, retapamulin, and fusidic acid. Oral antibiotic therapy can be used for impetigo with large bullae or when topical therapy is impractical. Amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides are options, but penicillin is not. Natural therapies such as tea tree oil; olive, garlic, and coconut oils; and Manuka honey have been anecdotally successful, but lack sufficient evidence to recommend or dismiss them as treatment options. Treatments under development include minocycline foam and Ozenoxacin, a topical quinolone. Topical disinfectants are inferior to antibiotics and should not be used. Empiric treatment considerations have changed with the increasing prevalence of antibiotic-resistant bacteria, with methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus all documented. Fusidic acid, mupirocin, and retapamulin cover methicillin-susceptible S. aureus and streptococcal infections. Clindamycin proves helpful in suspected methicillin-resistant S. aureus infections. Trimethoprim/sulfamethoxazole covers methicillin-resistant S. aureus infection, but is inadequate for streptococcal infection.
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Affiliation(s)
- Holly Hartman-Adams
- West Virginia University Robert C. Byrd Health Sciences Center, Morgantown, WV, USA
| | - Christine Banvard
- West Virginia University Robert C. Byrd Health Sciences Center, Morgantown, WV, USA
| | - Gregory Juckett
- West Virginia University Robert C. Byrd Health Sciences Center, Morgantown, WV, USA
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Impetigo. Am Fam Physician 2014; 90:Online. [PMID: 25251010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Affiliation(s)
- Natasha Ip
- Department of Paediatrics, Lister Hospital, Stevenage, UK.
| | - Jane Hoddes
- Department of Paediatrics, Lister Hospital, Stevenage, UK
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Sandra L. Impetigo: treatment and management. Nurs Times 2014; 110:18-20. [PMID: 24683751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Impetigo is the third most common skin disease in children. It is highly infectious and can be transmitted through direct and indirect contact. This article discusses the types of impetigo, its cause, diagnosis and management, and highlights additional guidance and resources that can support practice.
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Comité Nacional de Infectología, SAP. [Skin and soft tissue infections in children: consensus on diagnosis and treatment]. ARCH ARGENT PEDIATR 2014; 112:96-102. [PMID: 24566790 DOI: 10.5546/aap.2014.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/15/2013] [Indexed: 11/12/2022]
Abstract
Skin and soft tissue infections are a common reason for consultation in primary health care centers. Data from the local epidemiology of these infections are rare, but Staphylococcus aureus and Streptococcus pyogenes are known to be the major etiologic agents. The appearance in recent years of community-originated strains of methicillin-resistant S. aureus and erythromycin-resistant pyogenes raises controversy in the choice of initial empirical treatment. This national consensus is for pediatricians, dermatologists, infectiologists and other health professionals. It is about clinical management, especially the diagnosis and treatment of community-originated skin and soft tissue infections in immunocompetent patients under the age of 19.
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Liaw FY, Huang CF, Hsueh JT, Chiang CP. Eczema herpeticum: a medical emergency. Can Fam Physician 2012; 58:1358-1361. [PMID: 23242894 PMCID: PMC3520662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Fang-Yih Liaw
- Department of Family and Community Health, Tri-Service General Hospital, Taipei City, Taiwan
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Abstract
Infection of humans by Abiotrophia defectiva, a nutritionally variant streptococcus, most commonly takes the form of endocarditis, though a variety of other manifestations ranging from central nervous system abscesses to orthopaedic infections have been seen. We report here what we believe is the first case of bullous impetigo associated with this organism.
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Affiliation(s)
- Heather M Anderson
- Sioux Falls Family Medicine Residency Program, Center for Family Medicine, Sioux Falls, SD 57105, USA
| | - Cathy Miller
- Department of Family Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD 57105, USA
- Sioux Falls Family Medicine Residency Program, Center for Family Medicine, Sioux Falls, SD 57105, USA
| | - Earl Kemp
- Department of Family Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD 57105, USA
- Sioux Falls Family Medicine Residency Program, Center for Family Medicine, Sioux Falls, SD 57105, USA
| | - Mark K Huntington
- Department of Family Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD 57105, USA
- Sioux Falls Family Medicine Residency Program, Center for Family Medicine, Sioux Falls, SD 57105, USA
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Nijkamp A, van Bommel-Slee DSJ. [An infant with blisters post partum]. Ned Tijdschr Geneeskd 2012; 156:A3076. [PMID: 22551744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A newborn boy was sent to the hospital immediately after birth because of pre-auricular vesicles on both cheeks. There were no other congenital anomalies. First we thought the lesions were caused by friction or by impetigo bullosa. Treatment with local antibiotic cream did not resolve the blisters. After 1 month the diagnosis 'focal pre-auricular dermal dysplasia' was postulated.
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Affiliation(s)
- Anke Nijkamp
- Ziekenhuisgroep Twente, afd. Kindergeneeskunde, Almelo, the Netherlands.
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van Ewijk R, op de Coul ME, Teeuw AHR, Wolf BHM. [Burns in children: child abuse or another cause?]. Ned Tijdschr Geneeskd 2012; 156:A5026. [PMID: 23171561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Burns are common in children but it is not always clear whether the burn is accidental or not. Child abuse should always be considered. We present two children in which the diagnosis only became clear after admission and further investigation. Patient A, a 15-month-old boy, had a burn on his left shoulder. The burn was assumed suspect in view of the unclear history given by the parents and a possible delay in their seeking help. The patient was ultimately diagnosed with impetigo bullosa and successfully treated with antibiotics. Patient B, a 24-month-old girl, had burns on both feet and her right hand, which were infected as a result of the delay in seeking help. The burns were identified as abuse-related. The child was removed from her mother's care and sent to a foster home. A well-defined work-up should be followed in case of burns in children.
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Affiliation(s)
- Roelof van Ewijk
- St. Lucas Andreas Ziekenhuis, afd. Kindergeneeskunde, Amsterdam, the Netherlands.
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40
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Abeck D. [Atopic eczema. Update of the therapeutic options]. MMW Fortschr Med 2011; 153:51-53. [PMID: 22329325 DOI: 10.1007/bf03368209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abbas O, Chedraoui A, Ghosn S. Acute extensive bullous eruption. Am Fam Physician 2010; 81:1019-1020. [PMID: 20387779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Ossama Abbas
- American University of Beirut Medical Center, Beirut, Lebanon
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Geria AN, Schwartz RA. Impetigo update: new challenges in the era of methicillin resistance. Cutis 2010; 85:65-70. [PMID: 20349679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Impetigo is a bacterial infection of the superficial epidermis most commonly seen in infants and children. It is clinically characterized by crusted erosions or ulcers that may arise as a primary infection in which bacterial invasion occurs through minor breaks in the cutaneous surface or a secondary infection of a preexisting dermatosis or infestation. Impetigo occurs in 2 forms: bullous and nonbullous. Staphylococcus aureus currently is the most common overall cause of impetigo, but Streptococcus pyogenes remains an important cause in developing nations. Community-acquired methicillin-resistant S aureus (CA-MRSA) poses a challenge because of its enhanced virulence and increasing prevalence in children. For limited uncomplicated impetigo, either topical mupirocin or fusidic acid is as effective if not more effective than systemic antibiotics. For extensive or complicated impetigo, systemic antibiotics may be warranted, but beta-lactam antibiotics should be avoided if methicillin-resistant S aureus (MRSA) is suspected.
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Affiliation(s)
- Aanand N Geria
- Dermatology and Pediatrics, New Jersey Medical School, Newark 07103-2714, USA
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Pawun V, Jiraphongsa C, Puttamasute S, Putta R, Wongnai A, Jaima T, Tithsayatikom P, Wattanasri S. An outbreak of hospital-acquired Staphylococcus aureus skin infection among newborns, Nan Province, Thailand, January 2008. Euro Surveill 2009; 14:19372. [PMID: 19883556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
In January 2008, we investigated a cluster of neonates with bullous impetigo in a hospital of northern Thailand in order to control the outbreak and identify a potential source of the infection. We reviewed medical records and working timetables of healthcare workers (HCWs) and conducted a case-control study. We performed an environmental study and took bacteriological samples from HCWs and equipments. According to our case definitions, we identified 16 confirmed cases and 14 probable cases. The attack rate was 42%. Most cases had skin blisters (28 cases) followed by pustules (five cases) and exfoliation (three cases). The location of the lesion was the trunk (17 cases), neck (14 cases) or armpits (nine cases). Nineteen cases had symptoms onset after discharge from hospital. Median age at onset was 4 days. The strain isolated from an infected newborn shared the same phage type as the contaminated equipment. Insufficient hand hygiene was an observed risk behaviour of HCWs and visitors. Exposure to a nasal carrier of Staphylococcus aureus (adjusted OR: 80.3, 95% CI: 4.8 - 1350.3) and ward sharing with a symptomatic case (adjusted OR: 35.6, 95% CI: 1.9 - 654.7) increased the risk of acquiring the infection. The outbreak ended abruptly after implementation of hand hygiene practices and equipment cleaning.
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Affiliation(s)
- V Pawun
- Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand.
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Krejci-Manwaring J, West DA, Tonkovic-Capin V. If at first you don't succeed: a difficult case of Linear IgA. Dermatol Online J 2009; 15:16. [PMID: 19931003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We present a patient with Linear IgA who was both difficult to diagnose and treat. Numerous biopsies were needed before a positive result could be returned. Trials of multiple systemic agents failed. Eventually, a second trial of dapsone was successful and well-tolerated. The case exemplifies the determination and perseverance that is often required by both patient and physician in pursuit of symptom relief.
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Levine N. Persistent facial eruption. Geriatrics (Basel) 2009; 64:30. [PMID: 20722246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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Welsh B. Blistering skin conditions. Aust Fam Physician 2009; 38:484-490. [PMID: 19575066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Blistering of the skin can be due to a number of diverse aetiologies. Pattern and distribution of blisters can be helpful in diagnosis but usually biopsy is required for histopathology and immunofluoresence to make an accurate diagnosis. OBJECTIVE This article outlines the clinical and pathological features of blistering skin conditions with a particular focus on bullous impetigo, dermatitis herpetiformis, bullous pemphigoid and porphyria cutanea tarda. DISCUSSION Infections, contact reactions and drug eruptions should always be considered. Occasionally blistering may represent a cutaneous manifestation of a metabolic disease such as porphyria. Although rare, it is important to be aware of the autoimmune group of blistering diseases, as if unrecognised and untreated, they can lead to significant morbidity and mortality. Early referral to a dermatologist is important as management of blistering skin conditions can be challenging.
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Affiliation(s)
- Belinda Welsh
- St Vincent's Hospital, Melbourne and Sunbury Dermatology and Skin Cancer Clinic, Sunbury, Victoria.
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Patton T, Jukic D, Juhas E. Atypical histopathology in bowel-associated dermatosis-arthritis syndrome: A case report. Dermatol Online J 2009; 15:3. [PMID: 19379647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Bowel-associated dermatosis-arthritis syndrome (BADAS) is characterized by a prodrome of fever, chills, and flu-like symptoms with subsequent skin eruptions, myalgias, and polyarthralgias. The syndrome was initially described following jejunoileal bypass surgery for weight loss. Histopathology of the skin lesions present in BADAS is described in the literature as identical to that of Sweet syndrome. We present a patient whose clinical history and physical exam were consistent with the diagnosis of BADAS. Dermatopathology in this case demonstrated a large subcorneal pustule without a significant dermal neutrophilic infiltrate. The histologic differential included subcorneal pustular dermatosis, bullous impetigo, or IgA pemphigus. The histology in BADAS may not necessarily be identical to Sweet syndrome, and the clinical picture alone plays an important role in diagnosis. The correct diagnosis of BADAS prevents a myriad of laboratory tests and allows for more effective symptom management in this chronic condition.
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Affiliation(s)
- Timothy Patton
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Millard T. Identifying impetigo. Interview by Lynne Pearce. Nurs Stand 2009; 23:24. [PMID: 19186629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Impetigo is a common condition, particularly among children. But it is often misdiagnosed.
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Langemo D, Thompson PA, Hunter S, Hanson D, Anderson JW. Managing cellulitis and impetigo. Nursing 2008; 38:57-58. [PMID: 18719498 DOI: 10.1097/01.nurse.0000334654.12950.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Diane Langemo
- University of North Dakota College of Nursing in Grand Forks, ND, USA
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olde Hartman TC, Uijen AA. [The practice guideline 'Bacterial skin infections' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice]. Ned Tijdschr Geneeskd 2008; 152:1602-1603. [PMID: 18998264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The revised guideline 'Bacterial skin infections' from the Dutch College ofGeneral Practitioners offers a clear and extensive overview of the most prevalent superficial and deep bacterial infections in general practice. Given the lack of evidence, it is no longer recommended to keep children with impetigo out of school or daycare centres. Erysipelas and cellulitis are now considered variants of the same bacterial infection and require the same therapy. Due to its rising prevalence, methicillin-resistant Staphylococcus aureus should also be considered. In conclusion, the guideline is a practical and evidence-based tool for the diagnosis, education and treatment of bacterial skin infections.
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Affiliation(s)
- T C olde Hartman
- Universitair Medisch Centrum St Radboud, afd. Huisartsgeneeskunde, Postbus 9101, 6500 HB Nijmegen.
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