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Bullous impetigo
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Bullous impetigo

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Contributors: Molly Plovanich MD, Belinda Tan MD, PhD, Susan Burgin MD
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Synopsis

This summary discusses adult patients. Bullous impetigo in children is addressed separately.

Bullous impetigo is a superficial infection of skin typically caused by phage group II staphylococci and, less often, by other staphylococci phages. Additionally, there have been a few reports of beta-hemolytic streptococci causing bullous impetigo. It is primarily seen in children and does not commonly occur in teenagers or young adults. It presents as a painful, red rash with fragile bullae and honey-colored crusting. Constitutional symptoms such as fever are rare and mild, if they occur. Outbreaks tend to occur during the summer months and in humid climates. Staphylococcus aureus can secondarily infect the lesions of varicella, causing a bullous presentation to varicella.

Methicillin-resistant S. aureus (MRSA) first emerged as an important nosocomial pathogen in the 1960s. In more recent years, outbreaks of community acquired (CA)-MRSA have been described increasingly among healthy individuals lacking the traditional risk factors for such infections (IV drug use, incarceration, participation in contact sports, etc). It has been shown that the majority of purulent skin and soft tissue infections presenting to emergency rooms across the United States are caused by CA-MRSA.

Immunocompromised Patient Considerations:
Pyodermas (cutaneous bacterial infections) including impetigo are quite common in human immunodeficiency virus (HIV)-infected patients. Additionally, pyodermas are found in immunosuppressed transplant patients, especially in the first months following transplant.

Recurrent bouts of impetigo are more common in immunocompromised patients. This may be due to persistent nasal carriage of S. aureus, which has been reported to be as high as 50% in patients with HIV.

Codes

ICD10CM:
L01.03 – Bullous impetigo

SNOMEDCT:
399183005 – Bullous impetigo

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

If persistent and recurrent, consider primary bullous diseases such as pemphigus vulgaris, bullous pemphigoid, epidermolysis bullosa acquisita, linear IgA dermatosis, and dermatitis herpetiformis.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 07/28/2017
Last Updated: 07/31/2017
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Bullous impetigo
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Bullous impetigo : Crust, Flaccid bullae, Yellow color
Clinical image of Bullous impetigo
A close-up of a crusted erosion with a collarette of scale.
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