Summary about Disease
Bullous impetigo is a contagious bacterial skin infection characterized by large, fluid-filled blisters (bullae) primarily affecting infants and young children. It is a localized form of impetigo caused by strains of Staphylococcus aureus bacteria that produce an exfoliative toxin. Unlike non-bullous impetigo, the blisters in bullous impetigo tend to remain intact longer and do not usually form a thick crust.
Symptoms
Large Blisters (Bullae): These are the hallmark of bullous impetigo, typically 1-5 cm in diameter. They are clear, fluid-filled blisters that are thin-roofed and easily ruptured.
Location: Commonly found on the trunk (chest and back), arms, and legs. They can also appear in the diaper area of infants.
Pain: Usually not very painful, but the blisters can be itchy or uncomfortable.
Redness: The skin around the blisters may be slightly red or inflamed.
Systemic Symptoms (Rare): Fever and swollen lymph nodes are uncommon, but can occur in severe cases.
Ruptured Blisters: When blisters rupture, they leave behind a shallow, moist erosion rather than the thick, golden-yellow crust seen in non-bullous impetigo.
Causes
Staphylococcus aureus: Bullous impetigo is caused by specific strains of Staphylococcus aureus* bacteria that produce an exfoliative toxin (usually exfoliative toxin A).
Exfoliative Toxin: This toxin disrupts cell adhesion in the superficial layers of the skin, leading to the formation of blisters.
Breaks in the Skin: Bacteria enter through cuts, abrasions, insect bites, or other breaks in the skin.
Poor Hygiene: Poor hygiene practices can contribute to the spread of the bacteria.
Medicine Used
Topical Antibiotics: Mild cases may be treated with topical antibiotics like mupirocin or retapamulin. Applied directly to the affected area.
Oral Antibiotics: More severe or widespread infections require oral antibiotics. Commonly prescribed options include cephalexin, dicloxacillin, or clindamycin.
Antibacterial Soaps/Cleansers: Gentle cleansing with antibacterial soap can help reduce the bacterial load on the skin.
Is Communicable
Yes, bullous impetigo is highly contagious. It spreads through direct contact with the blisters or with items that have come into contact with the infected area (e.g., towels, clothing).
Precautions
Hand Hygiene: Frequent handwashing with soap and water, especially after touching the affected area.
Avoid Touching Blisters: Refrain from touching or scratching the blisters to prevent spreading the infection.
Cover Affected Areas: Keep the affected areas covered with a clean bandage or clothing to prevent contact with others.
Separate Towels and Linens: Use separate towels and linens for the infected person and wash them frequently in hot water with detergent.
Avoid Sharing Personal Items: Do not share personal items such as towels, clothing, razors, or sports equipment.
Clean and Disinfect: Regularly clean and disinfect surfaces that may have come into contact with the bacteria.
Stay Home: Infected individuals, especially children, should stay home from school or daycare until the infection is no longer contagious (usually after 24-48 hours of antibiotic treatment).
How long does an outbreak last?
With appropriate antibiotic treatment, bullous impetigo typically clears up within 7-10 days. Without treatment, it can persist for several weeks and may spread to other parts of the body or to other people.
How is it diagnosed?
Clinical Examination: Diagnosis is usually made based on the characteristic appearance of the blisters during a physical examination.
Gram Stain and Culture: A sample of fluid from a blister can be Gram stained and cultured to confirm the presence of Staphylococcus aureus and rule out other infections. This is not always necessary for diagnosis.
Rule out other diseases: In very rare cases a skin biopsy may be used to rule out other diseases.
Timeline of Symptoms
Initial Stage: Small red spots or bumps may appear.
Blister Formation: Within 1-3 days, the characteristic large, fluid-filled blisters develop.
Blister Rupture: Blisters may rupture spontaneously, leaving shallow erosions.
Healing: With treatment, the lesions begin to heal within a few days, and the infection typically clears within 7-10 days.
Important Considerations
Prompt Treatment: Early diagnosis and treatment are crucial to prevent the spread of infection and minimize complications.
Complete Antibiotic Course: It's important to complete the full course of prescribed antibiotics, even if the infection seems to be improving, to ensure eradication of the bacteria.
Monitor for Complications: Watch for signs of more serious infection, such as fever, spreading redness, or pain, and seek medical attention if these occur.
Recurrent Infections: Individuals with recurrent impetigo infections may need to be screened for nasal carriage of Staphylococcus aureus.
Differentiate from Other Conditions: Bullous impetigo needs to be differentiated from other blistering skin conditions such as staphylococcal scalded skin syndrome (SSSS), which is a more serious systemic illness.