Contents

SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferences

Information for Patients

View all Images (43)

Nonbullous impetigo in Adult
Other Resources UpToDate PubMed

Nonbullous impetigo in Adult

Contributors: Erin X. Wei MD, Molly Plovanich MD, Catherine J. Wang, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Nonbullous impetigo is a highly contagious superficial skin infection. It is primarily caused by Staphylococcus aureus in industrialized countries. However, group A streptococcus (Streptococcus pyogenes) remains a common cause of nonbullous impetigo in developing countries. In temperate climates, S aureus causes 90%-95% of cases, and S pyogenes or a combination of both S aureus and S pyogenes account for 5%-10% of cases.

Nonbullous impetigo has a predilection for children, affecting around 12% of children, compared to affecting about 5% of adults globally. Impetigo in adults usually results from extensive close contact with infected children or dermatologic conditions that predispose to superficial infection, such as minor trauma, atopic dermatitis, or infestation (eg, scabies). Small epidemics can occur in crowded environments, such as army barracks.

Clinically, impetigo presents as erythematous vesicles and/or pustules that quickly transition into superficial erosions with a characteristic "honey-colored" crust. Lesions are most commonly seen on the face (eg, around the nose and mouth) and extremities. With the exception of mild lymphadenopathy, patients with impetigo generally have no associated systemic symptoms.

Approximately 50% of patients with nonbullous impetigo will experience recurrent episodes within 12 months and require repeated courses of antibiotics.

Although MRSA infection of the skin usually presents as recurrent furunculosis or skin abscesses, MRSA has been shown to cause impetigo in 1%-10% of cases. Culture and sensitivities should always be performed in patients with lesions suspicious for cutaneous infection, and empiric coverage for MRSA should be instituted if clinical suspicion is high.

An infrequent complication of impetigo is acute poststreptococcal glomerulonephritis (APSG), which is caused by particular serotypes of S pyogenes that are nephritogenic. The risk of APSG is not reduced when antibiotic treatment is administered. Importantly, acute rheumatic fever has not been associated with impetigo.

Immunocompromised Patient Considerations:
Pyodermas (cutaneous bacterial infections) including impetigo are quite common in HIV-infected patients. Additionally, pyodermas are found in immunosuppressed transplant patients, especially in the first months following transplant.

Recurrent bouts of impetigo are more common in immunocompromised patients. This may be due to persistent nasal carriage of Staphylococcus, which has been reported to be as high as 50% in patients with HIV infection.

Codes

ICD10CM:
L01.01 – Non-bullous impetigo

SNOMEDCT:
238374001 – Non-bullous impetigo

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

To perform a comparison, select diagnoses from the classic differential

Subscription Required

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Reviewed:02/26/2024
Last Updated:02/27/2024
Copyright © 2024 VisualDx®. All rights reserved.
Patient Information for Nonbullous impetigo in Adult
Print E-Mail Images (43)
Contributors: Medical staff writer
Premium Feature
VisualDx Patient Handouts
Available in the Elite package
  • Improve treatment compliance
  • Reduce after-hours questions
  • Increase patient engagement and satisfaction
  • Written in clear, easy-to-understand language. No confusing jargon.
  • Available in English and Spanish
  • Print out or email directly to your patient
Copyright © 2024 VisualDx®. All rights reserved.
Nonbullous impetigo in Adult
A medical illustration showing key findings of Nonbullous impetigo : Skin erosion, Yellow color
Clinical image of Nonbullous impetigo - imageId=277147. Click to open in gallery.  caption: 'Numerous discrete and confluent, honey-colored crusts, some hemorrhagic crusts, and surrounding erythema on and around the lips.'
Numerous discrete and confluent, honey-colored crusts, some hemorrhagic crusts, and surrounding erythema on and around the lips.
Copyright © 2024 VisualDx®. All rights reserved.