Impetigo in Darker Skin: Diagnosis and Management

00:01 So how do we diagnose these conditions? The clinical history and physical examination findings will assist us in terms of what we are dealing with.

00:10 We also do a swab and do a gram stain and culture to try and identify the implicated organism and the differential diagnosis of nonbullous impetigo, which is the one that we spoke about firstly, which includes contact dermatitis.

00:29 Eczema herpeticum where one gets herpes simplex virus infection infecting a patient with atopic eczema.

00:40 Other blistering skin conditions, for example pemphigus vulgaris, pemphigus foliaceus can also be differentials.

00:49 What about ecthyma? Pyoderma gangrenosum, which is a chronic ulcerative skin condition, can be easily confused with ecthyma, but it's usually prolonged and it may be associated with other medical conditions, for example IBS and other irritable bowel syndrome conditions.

01:15 It may also be associated with underlying malignancy.

01:20 The other differential is Buruli ulcer.

01:24 It's documented, but it's uncommon, usually seen in tropical areas and is caused by the atypical mycobacteria.

01:34 How do we manage these patients? It's very important to try and identify the etiological agent.

01:41 And this we do by doing a swap which we send for microscopic culture and sensitivity. Prescription of a broad spectrum antibiotic is recommended whilst one is waiting for lab results.

01:56 If there are few lesions and it's mild skin conditions, we use topical therapy and the first line treatment could be mupirocin or fusidic acid.

02:09 If there are lots of lesions, oral antibiotics are given over a seven-day treatment course. This depends on the sensitivity that one gets after getting your culture results.

02:23 If there are numerous lesions, the following antibiotics can be used, especially for extensive and severe bacterial infections.

02:34 We also advise patients to generally make sure that they soak the affected area in warm water, or use wet compressions to remove the scabs.

02:43 So this is the message that you can convey to your patients.

02:48 So how do we prevent the spread of impetigo? The patients are advised to gently wash the affected area with mild soap and running water. Try and wash the hands thoroughly after applying the patient's treatment, try and keep the child at home until the infection is cleared to prevent contamination.

03:08 Remember, we mentioned that one of the risk factors happens through contact at schools and overcrowded areas.

03:17 For frequent reinfections, we do recommend prophylactic intranasal spray to decrease staph colonization, particularly in patients with atopic eczema or other skin conditions with impaired skin barrier.