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Topical therapies for some common pediatric bacterial skin infections
are outlined in Table 367-1.
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Impetigo is a highly contagious infection of the superficial
epidermis noted predominantly in preschool-age children. Although
group A β-hemolytic streptococci (GABHS) were traditionally
most frequently isolated in the United States, Staphylococcus
aureus now appears to predominate. Community-acquired methicillin-resistant S
aureus (MRSA) has been present for more than a decade,
but has more recently become more widespread, now representing approximately 90% of
MRSA infections in cutaneous and subcutaneous tissue in children.1,2 Children
in daycare and athletes are some of the persons at higher risk,
but most patients are young, healthy, and immunocompetent.1 When
diagnosing and treating infections caused by S aureus,
the possibility of MRSA must be considered, particularly when standard
treatment is not efficacious. See Chapter 284 for
more information regarding MRSA and treatment considerations. Anaerobic
bacteria are a less common cause of impetigo. In general, intact
skin is resistant to impetiginization, and some form of compromise
of the epidermal surface is necessary to permit infection. Predisposing
factors include minor abrasions and lacerations, arthropod bites,
burns, varicella, and several types of dermatitis, especially atopic
dermatitis. Exposed areas such as the face, arms, and legs are most
commonly affected, and impetigo is most common during the summer months.
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Impetigo usually presents in one of two clinical forms. Nonbullous (crusted)
impetigo, which accounts for more than 70% of cases, begins with
small vesicles or vesiculopustules that rupture rapidly, leaving behind
a honey-colored crust superimposed on a moist red base. Lesions
are minimally symptomatic, although mild pain or pruritus may be
present. Autoinoculation of the infection from scratching or digital
manipulation may result in the spread of lesions. Associated findings
include lymphadenopathy in 90% of patients, and leukocytosis,
in up to 50% of cases.
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Bullous impetigo is caused by infection with
a toxin-producing strain of S aureus, primarily
by phage group 2 or type 71, and less commonly types 3A, 3B, ...