Impetigo, Bullous

Contact Precautions

Impetigo (impetigo contagiosa) is a vesiculopustular eruptive disorder that spreads most easily among infants, young children, and elderly people. It appears most commonly on the face (usually around the nose and mouth) and other exposed areas.

Infants and young children may develop aural impetigo, or otitis externa. These lesions usually clear without treatment in 2 to 3 weeks unless an underlying disorder, such as eczema, is present. Candidal organisms, additional bacteria, fungi, or viruses may complicate lesions in the diaper area. In addition, impetigo may complicate chickenpox, eczema, and other skin disorders that are marked by open lesions.

Causes

Caused by coagulase-positive Staphylococcus aureus, bullous impetigo starts as a blister. Beta-hemolytic streptococci produce the nonbullous form of impetigo, which later also may harbor staphylococci, producing a mixed-organism infection. Predisposing factors, such as poor hygiene, anemia, malnutrition, and a warm climate, favor outbreaks of this infection, which is more prevalent in late summer and early fall. Methicillin-resistant S. aureus (MRSA) is becoming a common cause of impetigo.

Complications

Complications of impetigo include glomerulonephritis (rare), which is caused by a nephritogenic strain of beta-hemolytic streptococci, and ecthyma. If the infection becomes systemic, meningitis, bacteremia, and osteomyelitis may result. Since the epidermal layer of the skin sloughs, large areas of skin loss and permanent scarring may also occur.

Assessment Findings

The patient history discloses exposure to insect bites or other predisposing factors. Additionally, the patient may relate a history of painless pruritus and burning.

Recognizing Impetigo