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 or sepsis is another rare, but serious consequence.9

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