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How To Cure Impetigo By Stephen Sanderson

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Fast Impetigo Cure Summary

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Impetigo

The dorsal aspect of the distal phalanx may be involved by impetigo (Figure 5.39). It presents in two forms The latter is characterized by the appearance of large, localized, intra-epidermal bullae that persist for longer periods than the transient vesicles of streptococcal impetigo which subsequently rupture spontaneously to form very thin crusts. The lesions of bullous impetigo may mimic the non-infectious bullous diseases (such as drug-induced types or pemphigoid). Oral therapy of bullous impetigo with a penicillinase-resistant penicillin should be instituted and continued until the lesions resolve. Cephalexin and erythromycin are acceptable alternatives. The lesions should be cleansed several times daily and topical aureomycin (3 ) applied to all the affected areas. Impetigo of the nail apparatus. Impetigo of the nail apparatus.

Other Important Medical Conditions to Consider in Sports Participation

Certain conditions, including HIV and various skin conditions (i.e., herpes simplex, impetigo, scabies, and molluscum contagiosum), may cause concern for other athletes. Athletes with these skin conditions should avoid sports involving mats and cover all skin lesions. Athletic personnel should always use universal precautions when handling blood or body fluids with visible blood.

Herpes Zoster Clinical Summary

Early as the first week of life in infants born to mothers who contracted varicella during pregnancy. These lesions present as clustered vesicles in a dermatomal distribution. Pain is intense and in certain cases can persist beyond 1 month after the lesions have disappeared (known as postherpetic neuralgia). The diagnosis is usually made clinically however, tissue cultures, direct fluorescent antibodies, and Tzanck smears (see Fig. 25.28) can be done from vesicle scrapings for confirmation. Impetigo and cutaneous burns (cigarette) may mimic the appearance of herpetic vesicles. Varicella (chickenpox) is more diffusely spread, although a small crop of lesions may mimic zoster. Zoster also may be confused with herpes simplex virus (HSV) infection although a close examination should reveal a dermatomal distribution in zoster.

Staphylococcal Scalded Skin Syndrome Clinical Summary

Staphylococcal scalded skin syndrome most commonly affects infants and children less than 5 years of age and is caused by an exfoliative exotoxin-producing strain of Staphylococcus aureus. Initial presentation includes fever, malaise, and irritability following an upper respiratory infection with pharyngitis or conjunctivitis. Patients develop a diffuse faint erythematous rash that becomes tender to touch. Crusting around the mouth, eyes, and neck is not uncommon. Within 2 to 3 days, the upper layers of epidermis may be easily removed finally flaccid bullae develop with subsequent exfoliation of the skin. In young patients, this exfoliation may involve a large surface area with significant fluid and electrolyte losses. The differential diagnosis includes toxic epidermal necrolysis, exfoliative erythroderma, bullous erythema multiforme, bullous pemphigoid, bullous impetigo, sunburn, acute mercury poisoning, toxic shock syndrome, and epidermolysis bullosa.

Upon completion of the chapter the reader will be able to

Impetigo commonly afflicts young children, is usually caused by Group A streptococci or Staphylococcus aureus, and is characterized by numerous blisters that rupture and form crusts. Dicloxacillin, cephalexin, and topical mupirocin are considered the antibiotics of choice for treatment of impetigo.

Clinical presentation and diagnosis

Impetigo lesions are numerous, well-localized, and erythematous. They develop either as small, thin-walled blisters (impetigo contagiosum), or as larger blisters (bul- lous impetigo) which may be associated with mild systemic symptoms. ' S. aureus is most often implicated in bullous impetigo. The blisters rupture easily, leaving behind a friable crust reminiscent of cornflakes. The lesions of impetigo are rarely painful, but are pruritic. Scratching the lesions can spread the infection to other areas of the body.7 In order to avoid further spread and complications, antibiotic therapy is usually indicated. If left untreated, mild, localized cases of impetigo typically resolve within two to three weeks.7,10 Sequelae of impetigo are uncommon, and when complications do occur, they seem to be more frequent in adults. Rarely, glomerulonephritis secondary to Group A streptococcus (GAS) may occur in nonbullous impetigo. Development of impetigo into more serious infections such as cellulitis...

Streptococcal Diseases

Streptococci are responsible for many common and not so common human and animal diseases. Streptococcal pharyngitis, scarlet fever, impetigo, erysipelas, neonatal meningitis and sepsis, puerperal sepsis, and bacterial endocarditis all follow infection with streptococci. In addition, some streptococci provoke two peculiar postinfectious conditions acute rheumatic fever and acute glomerulonephritis. Rebecca Lancefield (1933) divided streptococci into distinct serologic groups, labeled A, B, C, D . . . , each with a number of separate subgroups. In addition to these groups, microbiologists further classify streptococci on whether and how they hemolyze red blood cells (alpha incomplete or green hemolysis beta complete or clear hemolysis). According to this tradition, the streptococcus responsible for pharyngitis is known as a group A beta-hemolytic streptococcus. Another member of the genus Streptococcus is the Streptococcus pneumoniae, the bacteria responsible for pneumonia....

Pharmacologic Treatment

Causative organism, penicillin has been the mainstay of therapy. However, the incidence of S. aureus impetigo is increasing, so oralpenicillinase-stable penicillins or first-generation cephalosporins are now preferred. Clindamycin or a macrolide are alternative choices when penicillin allergy is a concern however, the clinician should

Blistering distal dactylitis

Dactylitis

Blistering distal dactylitis is a variant of streptococcal skin infection. It presents as a superficial, tender, blistering beta-haemolytic streptococcal infection over the anterior fat pad of the distal phalanx of the finger (Figure 5.40). The lesion may or may not have a paronychial extension. This blister, containing thin, white pus, has a predilection for the tip of the digit and extends to the subungual area of the free edge of the nail plate. The area may provide a nidus for the beta-haemolytic streptococcus and act as a focus of chronic infection similar to the nasopharynx. The age range of affected patients is 2-16 years. For local care incision, drainage and antiseptic soaking are indicated, giving a more rapid response than systemic antibiotic therapy alone effective regimens include benzylpenicillin (penicillin G) in a single intramuscular dose, a 10-day course of oral phenoxymethylpenicillin or eryhromycin ethyl succinate. This type of treatment decreases the reservoir of...

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Impetigo Penis And Testicles

Erythema toxicum neonatorum is a benign, self-limited eruption of unknown etiology that occurs in up to 70 of term newborns characterized by discrete, small, erythematous macules or patches up to 2 to 3 cm in diameter with 1- to 3-mm firm pale yellow or white papules or pustules in the center. The trunk is predominantly involved. This rash usually presents within the first 24 to 72 hours of life. The distinctive feature of erythema toxicum is its evanescence or disappearance with each individual lesion usually disappearing within 2 or 3 days. New lesions may occur during the first 2 weeks of life. The neonate should appear well and lack any systemic signs of illness other than occasional peripheral eosinophilia. Wright-stained slide preparations of the scraping from the center of the lesion demonstrate numerous eosinophils. The differential diagnosis includes transient neonatal pustular melanosis, newborn milia, miliaria, neonatal herpes simplex, bacterial folliculitis, candidiasis,...

Epidemiology and etiology

Impetigo, which stems from the Latin word for attack, is a common skin infection worldwide.7 It predominately afflicts children between 2 and 5 years of age but may occur in any age group.1 -hemolytic streptococci and S. aureus are the most common causative pathogens1, Impetigo is a superficial infection and is spread eas ily, especially in settings of poor hygiene and crowding, and particularly during the summer months. The offending microorganisms colonize the skin surface and invade through abrasions, insect bites, or other small traumas. The scabby, crusty eruption of impetigo ensues. These lesions may occur anywhere on the body, but are most common on the face and extremities.1

Blistering Distal Dactylitis Clinical Summary

Blistering distal dactylitis is a cellulitis of the fingertip caused by Group A 3-hemolytic streptococci or Staphylococcus aureus infection in children from infancy to teenage years. The typical lesion is a fluid-filled, painful, tense blister with surrounding erythema located over the volar fat pad on the distal portion of a finger or toe. Polymorphonuclear leukocytes and gram-positive cocci can be found in the Gram stain of the purulent exudate from the lesion. The differential diagnosis includes bullous impetigo, burns, friction blisters, and herpetic whitlow.

Paronychia

The proximal nail fold, with its distal cuticle attached to the nail and the ventral eponychium, is normally well adapted to prevent infections and external inflammatory agents entering the proximal matrix area the same is true of the lateral nail walls and folds. It is therefore probable that no paronychia is truly primary, there always being some physical or chemical damage preceding the infection or inflammation this is less true in relation to superficial infections on the dorsum of the proximal nail fold, such as 'bulla repens' (a bullous form of impetigo).

Scabies

Scabies probably existed in Korea and China from ancient times. Since the fifteenth century, Korean doctors treated scabies with remedies that included sulfur poultices and arsenic sulfide. Avison reported that scabies was very common among his patients, as were scalp eruptions from head lice, and various forms of suppurating sores on other parts of the body (Avison 1897). The itch-mite, Sarcoptes scabiei, which causes scabies, is only one of the varieties of mites found in Korea. During the 1940s, scabies, trichophytous infections, and impetigo were quite common.

Bacterial Infections

Bacterial infections are common in sports, and treatment is similar for both athletes and nonathletes. Bacterial infections of the skin generally manifest as furuncles, carbuncles, impetigo, cellulitis, or erysipelas. Staphylococcal and streptococ-cal infections are most common, but community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), first reported in the late 1990s, has become a significant problem in athletic training facilities (Lindenmighter et al., 1998 Nguyen et al., 2005).

Clinical Summary

Impetigo is a focal bacterial infection of the superficial skin that is caused by Streptococcus pyogenes (group A 3-hemolytic Streptococcus) and Staphylococcus aureus. It most commonly affects children 2 to 5 years of age and usually involves the face and extremities. It begins as small vesicles or pustules with very thin roofs that rupture easily with the release of a cloudy fluid and the subsequent formation of a honey-colored crust. The lesions may spread rapidly by autoinoculation secondary to scratching and coalesce to form larger areas of infection. The differential diagnosis includes second-degree burns, varicella, herpes simplex infections, nummular dermatitis, superinfected eczema, and scabies.

Subject Index

See also acquired immune deficiency syndrome Alzheimer's disease, 16 myasthenia gravis, 225-27 pernicious anemia, 22 pneumocystis pneumonia, 254-55 pneumonia, 255-56 immunosuppressive drugs, 200 impetigo, 304 incipient stroke, 33 India. See South Asia Indian tick-typhus, 285 indigestion (dyspepsia), 105-7, 166 indomethacin, 154 industrial anthrax, 29 infant botulism, 57-58 infantile beriberi, 45, 48 infantile edema (kwashiorkor), 261-63 infantile gastroenteritis, 94 infantile paralysis, 258. See also poliomyelitis infantile pellagra (kwashiorkor), 261-63 infantile scurvy, 295, 297 infantile tetany, 329 infectious hepatitis, 171-74 infectious mononucleosis, 85, 174-75, 330 infectious parotitis, 222. See also mumps infectious pneumonia, 255. See also pneumonia infertility. See sterility inflammatory bowel disease (IBD), 175-78 influenza, 178-81 catarrh in, 70 characteristics, 178-79 croup and, 81

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