Bullous vs. Non-bullous Impetigo (Pediatric Nursing)

00:00 First, we'll cover non-bullous impetigo. This is the most common. The patient will have a red sore near the nose or mouth and it's going to start to leak pus or fluid. Then the patient will form a honey-colored scab or a honey-colored crust and this is the classic symptom. Then this will heal. The patient typically doesn’t have a lot of pain, but they will come in saying their lesion is itchy. They may have lymphadenopathy and this is the body's response to the infection and this can be spread easily to other parts of the body. Now we'll cover bullous impetigo. These are painless bullae which is a collection of big blisters created by the toxins produced by the Staph bacteria. We find this commonly in skinfolds including the axilla, the groin, between the fingers, and between the buttocks. This is red and itchy and is also a painless condition. And after these blisters break, the patient will form these yellow scabs.

00:57 So, on exam, we want to collect a full health history and check your patient's vital signs.

01:02 Next, you'll do a cardiac and respiratory exam and then focus on their skin. Remember you also want to check the patient's lymph system because they can have lymphadenopathy due to this infection. How do we diagnose impetigo? It's usually diagnosed based on the clinical exam. It's classic with this honey-colored crust. It's going to be found on the face, the arms or the legs, can be anywhere on the body though and you can do a bacterial culture but this is not always necessary because remember it's usually caused by Staph or Strep. So, the differential diagnoses, things that can look like impetigo but are not include contact dermatitis, herpes simplex virus. Remember always have that on your differential was this a primary herpetic lesion that is now secondarily infected, patients with discoid lupus and also scabies.

01:50 Now while we can treat impetigo, we also want to try to prevent the spread because it's very contagious. Patients want to keep their wounds clean and covered and practice strict handwashing.

02:00 You'd like your patients to keep their nails short so they reduce scratching and don't share clothing or linens. Patients can return to school or work after they've been on antibiotics for 24 hours and we want them to cover their lesions if they're draining. So we treat impetigo with antibiotics and typically topicals work including mupirocin but the patient may have a large surface area of impetigo. And they may need oral medication including dicloxacillin, erythromycin, augmentin, and the first generation cephalosporins. Now these are effective for methicillin-sensitive Staph aureus but if the patient has methicillin-resistant Staph aureus or MRSA, you'll have to treat with a different agent including doxycycline, clindamycin, or trimethoprim-sulfamethoxazole. Now remember your patient can have a secondary impetigo after a primary herpetic lesion so remember your patient may also need antivirals. There are a few complications to impetigo and it usually self-resolves in a few weeks, but the patient can develop a deeper skin infection called cellulitis and this can spread to the lymph nodes and the bloodstream. Your patient can also develop post-Strep glomerulonephritis and this is secondary to the Strep bacteria. Also there's Staph scalded skin syndrome and this is an illness characterized by red blistering skin that looks like a burn or a scald, hence its name.

03:22 Staph scalded skin syndrome is caused by the release of 2 exotoxins from the toxigenic strains of the Staph bacteria. Here is an example of the Staph scalded skin syndrome, and you can see the toxin lifts up the layers of the skin causing it to slough or peel off and these patients are managed at a burn center. The patient can also get scarring from their lesions and so you want to encourage them not to scratch.