From the Guidelines
Bullous impetigo typically presents as a superficial skin infection characterized by fragile, flaccid bullae that rupture easily, leaving behind honey-colored crusts and erythematous bases, most commonly caused by Staphylococcus aureus, specifically strains that produce exfoliative toxins, as noted in the 2014 update by the Infectious Diseases Society of America 1.
Key Characteristics
- The condition is often seen in children, particularly those under 2 years of age
- It has a predilection for the face, trunk, and extremities
- The diagnosis is usually clinical, based on the characteristic appearance of the lesions
Presentation
- Bullous impetigo begins as erythematous papules that rapidly evolve into vesicles and pustules that rupture, with the dried discharge forming honey-colored crusts on an erythematous base 1
- The bullae may rupture, often leaving a thin brown crust resembling lacquer, as described in previous guidelines 1
Treatment
- Treatment questions typically focus on topical mupirocin for limited disease and oral antibiotics for more extensive cases
- First-line options include cephalexin or dicloxacillin for 7-10 days, with alternative treatments such as clindamycin or trimethoprim-sulfamethoxazole considered in areas with high MRSA prevalence 1
From the Research
Presentation of Bullous Impetigo
- Bullous impetigo is a type of impetigo that results in large, flaccid bullae, and is more likely to affect intertriginous areas 2.
- It is caused exclusively by Staphylococcus aureus, and is characterized by the presence of large, flaccid bullae 2, 3.
- Bullous impetigo typically presents with large, fluid-filled blisters that may rupture and crust over, and can be accompanied by other symptoms such as redness, swelling, and itching.
Characteristics of Bullous Impetigo
- Bullous impetigo is less common than nonbullous impetigo, accounting for approximately 30% of cases 2.
- It can occur in individuals of all ages, but is most commonly seen in children aged 2-5 years 2, 4.
- The infection can spread through direct contact with an infected person or contaminated objects, and can also occur as a result of an insect bite or other skin lesion 2.
Treatment and Management
- Treatment for bullous impetigo typically involves the use of topical or oral antibiotics, such as mupirocin, retapamulin, or fusidic acid 2, 3.
- Oral antibiotic therapy may be necessary for more severe cases or when topical therapy is impractical 2.
- It is essential to note that the increasing prevalence of antibiotic-resistant bacteria, including methicillin-resistant S. aureus, may require alternative treatment approaches 2.