IMPETIGO - AN OVERVIEW

This article reviews in detail the pathogenesis, clinical characterist ics and management of impetigo in children. Impetigo is the most commo n bacterial skin infection of children. Most cases of nonbullous impet igo and all cases of bullous impetigo are caused by Staphylococcus aur eus. The remainder of cases of nonbullous impetigo are due to group A beta hemolytic streptococci (GABHS). GABHS colonize the skin directly by binding to sites on fibronectin that are exposed by trauma. In cont rast, S. aureus colonizes the nasal epithelium first; from this reserv oir, colonization of the skin occurs. Patients with recurrent impetigo should be evaluated for carriage of S. aureus. Superficial, localized impetigo may be treated successfully in more than 90% of cases with t opical application of mupirocin ointment. Impetigo that is widespread or involves deeper tissues should be treated with a beta-lactamase-res istant oral antibiotic. The choice of antibiotics is affected by the l ocal prevalance of resistance to erythromycin among strains of S. aure us, antibiotic cost and availability, and issues of compliance.