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Bullous impetigo is a bacterial skin infection caused by Staphylococcus aureus that results in the formation of large blisters called bullae , usually in areas with skin folds like the armpit, groin, between the fingers or toes, beneath the breast , and between the buttocks.

The bullae are caused by exfoliative toxins produced by Staphylococcus aureus that cause the connections between cells in the uppermost layer of the skin to fall apart. Bullous impetigo can appear around the diaper region, axilla , or neck. The bacteria causes a toxin to be produced that reduces cell-to-cell stickiness adhesion , causing for the top layer of skin epidermis , and lower layer of skin dermis to separate.

Vesicles rapidly enlarge and form the bullae which is a blister more than 5mm across. Bullae is also known as Staphylococcal scalded skin syndrome. Other associated symptoms are itching, swelling of nearby glands, fever and diarrhea. Pain is very rare. Long-term effects: once the scabs on the bullous have fallen off, scarring is minimal. Possible long-term effects are kidney disease. Exposure is most commonly seen in hospital wards and nurseries, and can be passed from person to person in other settings, such as close contact sports.

Therefore, the patient is advised to try to limit human contact as much as possible to minimize the risk of spreading the infection. After 48 hours the disease is considered no longer contagious assuming the proper antibiotic treatments have been administered. Exfoliating toxins are serine proteases that specifically bind to and cleave desmoglein 1 Dsg1. Which results in the cleavage of human Dsg1 at a unique site after glutamic acid residues causing deactivation.

A phyogenic non-motile Gram-positive cocci which forms into grape like clusters. Just like other forms of staph, S. These surface receptors allow a bridge to be formed which binds to host endothelial cells. Lipases allow for the degradation of lipids on the skin surface and its expression can be directly correlated with its ability of the bacteria to produce abscesses.

Observing the skin's physical appearance, or swabbing a culture of the lesion for S. The epidermis is composed of four layers, stratum basale , stratum spinosum , stratum granulosum , and stratum corneum. The cleavage plane can be found either subcorneally or within the upper stratum granulosum.

The roof of the pustule is parakeratotic stratum corneum, and the floor is formed of keratinocytes, which may or may not be acantholytic. Toxins are produced by S. This correlates with the subcorneal localization of the bullae. Since the common pathogens involved with impetigo are bacteria naturally found on the skin, most prevention especially in children , is targeted towards appropriate hygiene, wound cleaning, and minimizing scratching i.

Avoiding close contact and sharing of items such as towels with potentially infected individuals is also recommended. Antibiotic creams are the preferred treatment for mild cases of impetigo, despite their limited systemic absorption.

Such prescribed ointments include neosporin , fusidic acid , chloramphenicol and mupirocin. More severe cases of impetigo however especially bullous impetigo will likely require oral agents with better systemic bioavailability , such as cephalexin. Cases that do not resolve with initial antibiotic therapy or require hospitalization may also be indicative an MRSA infection, which would require the use of agents specifically able to treat it, such as clindamycin.

Antibiotic treatment typically last 7—10 days, and although highly effective some cases of methicillin resistant S.

From Wikipedia, the free encyclopedia. American Family Physician. Blistering disorders in infancy. Chicago: Robbins and Cotran, Histology of the normal skin.

ICD - 10 : Xxx. Categories : Bacterium-related cutaneous conditions. Namespaces Article Talk. Views Read Edit View history. Contribute Help Community portal Recent changes Upload file. In other projects Wikimedia Commons. By using this site, you agree to the Terms of Use and Privacy Policy.


Impetigo and Ecthyma

Only comments seeking to improve the quality and accuracy of information on the Orphanet website are accepted. For all other comments, please send your remarks via contact us. Only comments written in English can be processed. A rare, acquired, typically benign, bacterial infectious disease caused by Staphylococcus aureus characterized by large, fragile vesicles and flaccid bullae on an erythematous base, which evolve into moistened erosions with a thin, varnish-like crust, usually localized in intertriginous areas of the trunk and extremities armpits, groins, between the fingers or toes, beneath the breasts.


Bullous impetigo

Impetigo is a superficial skin infection with crusting or bullae caused by streptococci, staphylococci, or both. Ecthyma is an ulcerative form of impetigo. Diagnosis is clinical. Treatment is with topical and sometimes oral antibiotics.

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