ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferencesInformation for PatientsView all Images (45)
Bullous impetigo (pediatric) in Infant/Neonate
See also in: Anogenital
Print
Other Resources UpToDate PubMed

Bullous impetigo (pediatric) in Infant/Neonate

See also in: Anogenital
Print Patient Handout Images (45)
Contributors: Molly Plovanich MD, Belinda Tan MD, PhD, Amy Swerdlin MD, Gomathy Sethuraman MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

This summary discusses pediatric patients. Bullous impetigo in adults is addressed separately. 

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.

Codes

ICD10CM:
L01.03 – Bullous impetigo

SNOMEDCT:
399183005 – Bullous impetigo

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

  • 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.

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Reviewed: 07/28/2017
Last Updated: 07/31/2017
Copyright © 2019 VisualDx®. All rights reserved.
Bullous impetigo (pediatric) in Infant/Neonate
See also in: Anogenital
Print 45 Images Filter Images
View all Images (45)
(with subscription)
 Reset
Bullous impetigo (pediatric) : Diaper area, Flaccid bullae, Grouped configuration, Scattered few, Pustules, Vesicles
Clinical image of Bullous impetigo (pediatric)
Copyright © 2019 VisualDx®. All rights reserved.