Impetigo

The dorsal aspect of the distal phalanx may be involved by impetigo (Figure 5.39). It presents in two forms:

1 Vesiculopustular, with its familiar honey-crusted lesions, usually due to beta-haemolytic streptococci.

2 Bullous, usually due to phage type 71 staphylococci.

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.

Figure 5.39

Impetigo of the nail apparatus.

Figure 5.39

Impetigo of the nail apparatus.

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