Bullous impetigo (pediatric) in Infant/Neonate
Bullous impetigo is a localized form of staphylococcal scalded skin syndrome (SSSS) caused by exfoliative toxins (A and B) released by (phage group II) Staphylococcus aureus. These toxins cleave desmoglein 1, resulting in superficial blisters locally at the site of infection. It is primarily seen in children, especially infants, and only rarely occurs in teenagers or young adults. Constitutional symptoms and fever are rare and mild, if they occur. Outbreaks tend to occur during the summer months and in humid climates. The disease commonly affects moist intertriginous areas such as the axillae, neck, and diaper area; the face; and the extremities.
In neonates, the infection often presents in the first 2 weeks of life, and the intertriginous areas are commonly affected. Sometimes, bullous impetigo may result in serious infections like osteomyelitis, septic arthritis, pneumonia, and septicemia.
Bullous impetigo lesions initially present as flaccid bullae before rupturing, leaving round erosions that become crusted.
When involvement is more extensive, lesions may even be confused with scald burns. Also, cases have been reported of bullous impetigo affecting the vulvar region, leading to confusion with possible sexual abuse.
L01.03 – Bullous impetigo
399183005 – Bullous impetigo
- Erythema toxicum neonatorum – Usually noticed in the first few days of life. The lesions are erythematous macules or urticarial plaques topped with a 1-2 mm papule or pustule that spontaneously resolves within 1-2 days.
- Transient neonatal pustular melanosis – Presents in the immediate postnatal period and is characterized by vesiculopustules without associated erythema. The pustules rupture easily, leaving behind hyperpigmented macules that may be surrounded by a characteristic collarette of scale.
- Neonatal herpes simplex
- Herpes simplex virus (HSV) infection – Grouped vesicles on an erythematous base and polycyclic erosions, usually involving the face and scalp.
- Candidiasis – Erythematous patches with the typical satellite pustules in the intertriginous areas
- Epidermolysis bullosa simplex – Formation of blisters following abrasion-type skin trauma, usually around the hands, diaper, and feet.