Impetigo & Ecthyma

Non-Bullous Impetigo: The most common form. Starts as small vesicles or pustules that rupture to form classic honey-colored (golden) crusts on an erythematous base.

Bullous Impetigo: Caused by Staph. aureus toxins. Presents as large, thin-walled, transparent bullae (blisters) that contain clear or yellow fluid. When they rupture, they leave a "collarette" of scale around a moist red center.

Common Sites:

Usually affects the face (around the nose and mouth) and extremities. Highly contagious in children.

Ecthyma (Deep Impetigo)

• The Clue: "Punched-out" ulcers with a thick, greenish-yellow crust and raised violaceous (purple) margins.
• Vs Impetigo: Ecthyma penetrates deeper into the dermis and often leads to scarring. It is common on the lower legs of neglected or immunocompromised patients.

Erysipelas

• The Clue: Bright red, shiny, edematous plaque with sharply demarcated borders.
• Vs Impetigo: Involves the upper dermis and superficial lymphatics; presents with fever and systemic symptoms, unlike localized impetigo.

Topical Treatment (Localized):

• Mupirocin 2% ointment: BD/TDS for 7 days.
• Fusidic Acid 2% cream: BD/TDS for 7 days.
• *Gently remove crusts with warm water or saline before application.

Systemic Treatment (Extensive/Ecthyma):

• Cloxacillin: 500mg QID for 7 days. Children: 12.5mg/kg QID.
• Cephalexin: 1g BD for 7 days. Children: 25mg/kg BD.

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