Impetigo disease. Impetigo: diagnosis and treatment of the disease

The local immunity of babies is not yet formed, so they are more susceptible to bacterial skin infections. Impetigo is a very common dermatological pathology in children's groups (kindergartens, schools) and can become an epidemic. It is important to start treating the disease immediately, because it causes dangerous complications.

Causes of impetigo

The causative agents of the disease in question are staphylococci and streptococci. They provoke impetigo in a child only if there is damage to the epidermis. Even superficial scratches, small wounds and bites of blood-sucking insects can lead to the penetration of bacteria into the skin and the onset of an acute inflammatory process. Further spread Impetigo in children occurs due to the following conditions:

• combing rashes;
• direct contact with an infected child;
• use of shared clothing, toys, dishes and other items.

Predisposing factors for the spread of infection:

• warm and humid air;
• microtrauma on the skin;
• immunological disorders;
• deficiency of vitamins in the body;
• non-compliance with sanitary and hygienic rules;

Impetigo in children - symptoms

The clinical picture of the described pathology corresponds to the causative agent of infection and the form of skin lesions. It is important for parents to visually know all types of impetigo in a child, photos of rashes for each type of disease are presented below. Early detection signs of a bacterial disease and establishing the correct diagnosis ensures the maximum effectiveness of treatment and prevents serious complications.

Staphylococcal impetigo

A synonym for this form of infection is folliculitis. The specified type of acute impetigo in children is characterized by inflammation in the mouths of the hair. There are 2 forms of folliculitis, with proper therapy, both proceed easily. It is visually easy to determine staphylococcal impetigo in children - the photos below correspond to the description of the types of this disease:

1. Surface. Small (up to 2 mm) vesicles appear on the skin with white contents and a pink areola around, the epidermis between them does not change. Within 9-10 days, the blisters decrease or open with the expiration of pus. In their place, yellow crusts form, which gradually fall off without a trace.
2. Deep. The rash looks like large red nodules from 5 mm in diameter. The skin is inflamed, red and swollen. After 5-8 days, acne either resolves or suppurates more strongly. After resolution and healing of such rashes, scars often remain.

Streptococcal impetigo in children

The presented type of pathology develops less frequently, in about 10% of cases. Streptococcal impetigo is a multiform disease, the symptoms of which depend on the area of ​​the skin affected by bacteria. Kinds:

1. Classic (bubbly). On the eyelids, less often in other areas of the face, small superficial blisters form with transparent, cloudy or pinkish contents. They open on their own and become covered with crusts, which fall off after 6-7 days. Damaged areas initially have a bluish-violet pigmentation.
2. Dry pyoderma or lichen simplex. The skin is covered with red spots with pronounced peeling on the surface. Such impetigo in children may be accompanied by intense itching.
3. Zaedy. In the corners of the mouth, multiple small bubbles with viscous contents are formed. They quickly burst, giving way to slit-like erosion. Bleeding wounds within 2-3 hours are covered with a dense crust, which sometimes cracks when opening the mouth.
4. Felon. A conflict (abscess) appears on the periungual roller at the site of damage to the epidermis (puncture, burr). After its opening, a large erosion opens with the release of streptococcal contents.

Vulgar impetigo in children

If the causative agents of the disease are both staphylococci and streptococci, a mixed infection progresses. Vulgar impetigo looks like multiple blisters with pus on the skin of the face. Rarely, rashes are found on the limbs and trunk. As the opening and healing of the inflammatory elements are covered with dense and massive crusts. Without adequate therapy, strepto-staphylococcal impetigo quickly spreads to healthy areas of the skin. With an extensive lesion, nearby The lymph nodes they become swollen and sore.

Ring-shaped impetigo

This form of the disease in medicine is called circinary. It is one of the types of streptococcal impetigo in a child - the photo below clearly shows that the rash looks identical. Ring-shaped infection is characterized by the fusion of purulent vesicles and the formation of large blisters. The course of circanary impetigo is similar. After opening the pimples and removing their contents, the skin becomes covered with yellow-gray crusts, which quickly dry out and fall off.

bullous impetigo in children

Another type of streptococcal dermatological infection. Acute bullous impetigo is large (from 2 cm in diameter) spherical blisters with cloudy exudate. In the process of developing the pathology, the child's body temperature may increase, the lymph nodes become inflamed, weakness and headache are felt. The considered impetigo is often diagnosed in young children against the background of dermatoses or neurodermatitis. After opening the blisters, the skin becomes covered with a thick crust, which falls off on its own in 1-2 weeks.

Slit-like impetigo in children

One of the variants of the disease are seizures. Slit-like impetigo is provoked by streptococci, often the infection additionally affects the folds of the eyelids, ears and wings of the nose. In these areas, purulent vesicles are formed, after opening of which erosions open. Such ulcers heal slowly under the forming dry crust. Sometimes slit-like impetigo in children proceeds for a long time - it is important to start treatment immediately, otherwise constant self-infection occurs. Because of this, the infection spreads to nearby mucous membranes - in the nostrils, oral cavity, conjunctiva of the eyes.

How to treat impetigo in children?

In most situations, the pathology is mild, and therapy is carried out on an outpatient basis. Correct treatment of impetigo includes general measures:

• limiting contact of damaged skin with water;
• hypoallergenic diet;
• enrichment of the diet with vitamins and minerals;
• strict observance of sanitary and hygienic standards;
• quarantine.

Impetigo in children - treatment, drugs

Drug therapy according to the standard involves the use of only local remedies. Staphylococcal or streptococcal impetigo in children - treatment:

1. Antiseptic treatment of fresh rash. Pustules 2-3 times a day are wiped with camphor or salicylic alcohol.
2. antimicrobial therapy. After disinfection, an antibacterial ointment, Kolbiocin, tetracycline, heliomycin and others, is applied with a thin layer on the affected skin 3-4 times a day.
3. preventive treatment. When the blisters open, it is necessary to prevent the spread of infection. To do this, the resulting wounds and erosions are immediately treated, for example, with iodine, furatsilin, brilliant green and similar solutions.

Systemic medications are connected if generalized impetigo progresses and spreads rapidly - antibiotic treatment is carried out exclusively as directed by a doctor and under his supervision. Used drugs:

• Oxacillin;
• Cephalexin;
• Erythromycin;
• Cefadroxil;
• and others.

Treatment of impetigo folk remedies

Without local antibiotic therapy, alternative prescriptions cannot be used. Such treatment of impetigo in children is ineffective, it is allowed only in combination with conservative methods. Otherwise, the infection will spread to healthy tissues and progress. With impetigo in children, home treatment consists in drinking natural fortified drinks (fruit drinks, compotes, rosehip and dried fruit decoction), treating the skin with antiseptic herbal infusions or apple cider vinegar.

Impetigo belongs to the category skin diseases, the main risk group of which are children attending preschool institutions. The disease is quite contagious, therefore, without proper quarantine regime, the number of cases increases very quickly.

What it is?

Impetigo is a skin disease accompanied by the formation of vesicles with purulent contents. In addition to rashes, the course of the disease is accompanied by painful sensations and itching. Scientifically, impetigo is characterized as a superficial bacterial skin infection.

The reasons

In the vast majority of cases (about 80%), the disease is provoked by Staphylococcus aureus or beta-hemolytic streptococcus. In addition, risk factors include:

• traumatic damage to the skin;
• violation or failure to comply with the rules of personal hygiene;
• hereditary factor;
• diabetes;
• harmful working conditions;
• anemia;
• improper nutrition.

In addition, impetigo can act as a complication (secondary infection) against the background of such skin diseases as pediculosis, scabies, contact dermatitis, acariasis, eczema, chicken pox.

Types and differences

Depending on the form of the disease, the treatment prescribed also varies significantly. It is not possible to independently determine it, therefore, upon detection of the first rashes, it is necessary to urgently contact the medical institution.
There are three main types:

• a disease caused by streptococci;
• subspecies provoked by pathogens of staphylococcus aureus;
• vulgar-mixed type.

The first two are caused by one type of bacteria, while the latter is provoked by two viruses at once.

Streptococcal impetigo

The disease is infectious in nature and is caused exclusively by streptococci. Impetigo of this nature is very contagious - this indisputable fact has been proven in the course of numerous medical studies. The disease has no age restrictions and is transmitted both from children to children and to adults. Most often, rashes are localized on the face, sides, as well as upper and lower limbs. The main risk group is women and children, who have a thin and, as a result, more susceptible to pathogens, the stratum corneum.

The disease can develop over a long period of time, especially if a person has a habit of constantly rubbing his hands and licking his lips. The slit-like form of impetigo proceeds as follows:

• a small bubble appears at the junctions of the upper and lower lips, the appearance of which is accompanied by pain, itching and profuse salivation;
• after a while, the bubble opens, in its place a crust appears, which also disappears after a short period.

Ring-shaped impetigo begins with profuse rashes of a rather large size. Bubbles with cloudy contents quickly increase in size, and then, having reached a peak, begin to dry out, starting in the middle. As a result, ring-shaped figures are formed, which rarely appear singly. Most often, such rashes resemble a garland.

The causative agent penetrates the skin through the injured areas and causes the appearance a large number purulent eruptions. They are localized on the feet, hands and legs. Bubbles can be up to 5 cm in diameter! At the same time, along with pus, they can be filled with blood. The key feature of bullous impetigo is the fact that it never progresses to chronic form.

Small purulent vesicles appear at the mouths of the hair follicles and cause severe inflammation of the skin. The rashes pass very quickly, leaving a smooth, “lacquered” surface underneath. The disease affects mainly men and is localized mainly in the mustache and beard. There are no scars or any other marks on the skin.

Vulgar impetigo

This form of impetigo is caused by two types of bacteria - streptococci and staphylococci. The rash appears mainly around the mouth, eyes and nose. The disease develops according to the following principle:

1. Streptococcus pathogens penetrate under the skin through microcracks or damage. As a result of this, redness first occurs, and only then bubbles with cloudy contents appear.
2. After some time, a staphylococcal infection also joins the streptococci, against which the cloudy content of the blisters turns into pus.
3. After 5-7 days, the blisters burst and yellowish crusts appear in their place.
4. At the site of the rash usually remains dark spot, which disappears over time.

Symptoms

Features of the course of the disease vary, depending on the form of the disease. Most often, it all starts with peeling and redness of the skin, followed by the formation of blisters.
In the event that the epidermis is characterized by the presence of a thick stratum corneum, then the bubbles will not burst, but grow, uniting with each other. Under adverse external conditions, impetigo can be accompanied by serious complications in the form of lymphadenitis and lymphangitis.
Symptoms can manifest themselves not only on the open integuments of the epidermis, but also on the mucous membranes oral cavity, nasopharynx, eyes, etc.

Features in children

The most common form of the disease in children is streptococcal impetigo. The disease develops rapidly, and the first signs of the disease appear on the hands, feet, face. In infants, the emerging vesicles are usually very small, initially filled with a clear liquid. Over time, it becomes cloudy or bloody. Gradually, the bubbles burst and crusts appear in their place, which fall off after a few days. The final stage is the appearance of a pinkish spot in place of the crust, which also gradually disappears.

It is better for babies to wear special knitted mittens that will prevent involuntary mechanical damage to the bubbles.

At proper treatment recovery appears within a week. Only in the most rare cases, impetigo causes a deterioration in the general condition. Then the kids are additionally prescribed restorative therapy.

Treatment

Before prescribing the appropriate treatment, the patient must undergo a diagnostic procedure, which includes:

• assessment by a specialist of the external manifestations of the disease;
• questioning the patient to identify foci of infection and possible ways infection;
• delivery of outpatient tests (exudate sampling to identify the pathogen).

After the diagnosis is made, the patient is prescribed treatment. Its type depends on the form of the disease. The main components of a quick recovery are:

1. Compliance with the rules of personal hygiene. Thus, it is possible to prevent the spread of infection and ensure the speedy healing of wounds at the site of the bubbles.
2. Application local preparations based on antibiotics (for example, Bactroban). At the discretion of the attending physician, this can be any form: ointment or cream. Before applying the main drug, the affected area is treated with an antiseptic. In a severe form of the disease, antibiotics must also be taken orally.
3. Comprehensive body support. Depending on the strain of impetigo, the patient is prescribed immunostimulating, sulfa or anti-staphylococcal drugs. This is done in order to prevent the spread of infection and avoid complications.

It is important to remember one simple rule - the affected skin should not come into contact with water! Cleanliness can be maintained by treating wounds with salicylic alcohol or a special antibacterial solution. The course of treatment is usually up to 2 weeks.

In order to ensure that unwanted infection is avoided, patients need to eliminate all contributing factors:

• timely diagnosis and treatment of dermatological diseases;
• strict observance of basic rules of personal hygiene;
• treatment of wounds and abrasions with antiseptic preparations;
• strengthening immunity;
• compliance with quarantine measures and limiting contact with patients.

With the right approach to treatment, the disease does not become chronic, does not provoke a relapse and passes completely without a trace. The patient needs to be provided not only with comprehensive medical care but also quarantine. Otherwise, impetigo can be transmitted to all household members.

Impetigo - this is skin disease infectious nature. Pathology is manifested by the formation of vesicles and blisters with serous or purulent exudate inside in various parts of the body. When they are opened, the skin may itch, and then become covered with dense crusts.

The disease is caused by pathogenic flora, which, as a result of provoking factors, begins to multiply on the surface and (or) inside the epidermis.

Impetigo very contagious , is transmitted by household contact when communicating with a sick person or when using household items and hygiene products with him.

The infection has another scientific name - streptoderma. Studies show that it is extremely common in children's groups and regions with a hot tropical climate.

The main pathogens that cause disease are streptococci and staphylococci. These microorganisms are normally often present on the skin and mucous membranes of a person, but the immune system carriers does not allow them to multiply intensively, therefore, a combination of a number of reasons usually leads to the onset of impetigo.

Since the culprits of streptoderma are well studied, the pathology is easily treatable with modern antimicrobial drugs.

ICD-10 code

According to the medical classification, impetigo has its own code - L01, and is included in the group of infectious skin diseases with the formation of pustular or vesicular rashes.

At the height of the disease, the sites of localization of the rashes often merge and look like, partially dried and partially weeping.

According to advanced medical views, impetigo is considered a bacterial infection of the skin, which is caused mainly by streptococci (more than 80% of cases), less often by staphylococci (about 15%) or a combination of microbes (5%).

The most common is the primary infection, here the disease appears without a previous background pathology, less often the infection occurs as a complication of acute or chronic skin pathologies (dermatoses, erysipelas).

The course of impetigo is stadial :

• Phase 1 is reddening of the affected area;
• 2nd - the formation of bubbles with a clear liquid;
• 3rd - turbidity of the exudate and its exit to the outside (collapse of the elements of the rash);
• 4th - the formation and exfoliation of crusts;
• 5th - the appearance and resorption of residual pigmentation.

Causes

The factors causing the development of impetigo include:

Kinds

Most commonly diagnosed streptococcal impetigo. It has various variations:

one. " Dry» Streptoderma is characterized by the appearance on the body of bright red spots very similar to lichen.

2. bullous impetigo is expressed in the spread of dense conflicts (bulls) with bloody-purulent exudate. One of the severe forms of the disease, accompanied by severe weakness and symptoms of intoxication (fever, chills, sweating, nausea and headaches);

3. annular the form proceeds with a rash resembling a ring. Its elements open and dry in the center, and new blisters appear and grow on the periphery;

4. slit-like impetigo affects people who have cracks at the corners of their mouths (jammies). In this area or near the wings of the nose, areas with pustules form, after they burst, due to the mimic activity of the muscles of the face in this area, cracking of the crusts occurs in a slit-like type, this is a very painful and unpleasant process.

impetigo caused by staphylococci (ostiofolliculitis, Bockhart's impetigo) affects the hair follicles. The rash in this form has a papular-nodular character, it is dense and penetrates into the deep layers of the skin or may be shallow superficial with purulent contents.

When disease develops from activity strepto- and staphylococci at the same time , talking about mixed type of infection.

Vulgar impetigo is characterized by damage to the sweat and sebaceous glands epidermis, spots and rashes with it are usually large, dried crusts are greasy and voluminous. The affected areas are very painful, constantly itchy and therefore combed by patients, because of this, a new infection and complications (necrotization or scarring of the mucous membranes and tissues) are possible.

Symptoms

At the onset of the disease, pronounced redness and rash elements appear on the face and hands of patients.

Depending on the form of impetigo, the sizes of conflicts range from 1 to 5 mm. On examination, the papules show fluid (clear, whitish, yellow, or bloody). Gradually, the bubbles burst and in their place crusts and scales form, under them skin are restored and they fall off, leaving pigmentation on the body, which disappears within a month.

In adults, local and general manifestations of the disease are moderate and tolerated quite easily. An exception may be bullous and vulgar varieties of the disease, they are often complicated by secondary infections.

But even the simplest and most uncomplicated forms of impetigo in children are often more severe, with severe symptoms of intoxication of the body and the development of inflammation of nearby lymph nodes.

Treatment

The complex of measures for the treatment of impetigo includes:

• isolation of patients in a separate box or room, strict adherence to the rules for caring for him and preventive measures to prevent the spread of infection;
• taking antibiotics (tablets or injections, depending on the severity of the pathology), for which macrolides, penicillins, cephalosporins are often used;
• topical treatment with ointments, creams and gels (based on bacitracin, mupirocin, neomycin, erythromycin, tetracycline);
• symptomatic treatment with antihistamines, decongestants, analgesics and antipyretics;
• use during the recovery period of anti-inflammatory herbs (sage, calendula, chamomile) for the preparation of baths and compresses.

Adequate therapy in the hospital is prescribed by a dermatologist, he also gives recommendations on how to treat impetigo at home.

This disease is characterized by rapid spread and complications, therefore, in order to get rid of it, it is necessary to contact a medical institution in a timely manner. If treatment is started on time, impetigo completely disappears. in 7-10 days without complications for the body.

Video

Impetigo usually begins as painful red patches that progress through the vesicle stage to honey-crust-like scabs.

Occurs more often in children; in adults, men usually become infected by shaving; often occurs as a complication of other diseases (pruritus, etc.).

There are several forms of impetigo: streptococcal, staphylococcal, vulgar (mixed).

The disease is highly contagious.

Impetigo most often becomes the scourge of children's groups, especially often it occurs in groups of small, nursery children. Often observed in the form of home and school epidemics. Impetigo is dangerous because it can give complications from internal organs, so any outbreak of this disease is thoroughly investigated and children are treated.

Causes leading to the formation of impetigo

In more than 80% of cases, the causative agent of impetigo is represented by Staphylococcus aureus or beta-hemolytic streptococcus. The pathogen penetrates through cracks and abrasions of the skin, the mouth of the hair follicles.

Impetigo can occur as a primary disease or be a complication of an already existing dermatosis, such as neurodermatitis (secondary impetigo). Risk factors for developing impetigo:

Manifestations of impetigo

At streptococcal impetigo painful red spotty-tubercular rashes appear on the skin. The latter turn into small blisters up to 0.51 cm in diameter, filled with light, gradually cloudy contents, and then into usually painless blisters. Eruptions are scattered or crowded in groups, surrounded by a narrow rim of reddened skin. They open up quickly. After the rupture of the blisters, weeping superficial red ulcers appear, later they are covered with honey-colored crusts, which fall off after 57 days.

Most often, rashes appear on the open parts of the body, the face, shins, hands, but they can also be on other areas of the skin, at the site of damage to the skin.

The rash may develop quickly or slowly.

In children, the corners of the mouth are especially often affected by streptococcal congestion, the wings of the nose, skin folds behind auricles. They begin with the appearance of a bubble with flaccid thin skin in the corner of the mouth, in its place a slit-like erosion quickly forms, after removal of which, a red, moist, easily bleeding surface with a crack in the center is found. After 1-2 hours, the jam is again covered with a crust. The process may be accompanied by a slight soreness when opening the mouth. The process often extends to the oral mucosa. Sometimes impetigo occurs in isolation in the mouth, where painful erosions form on the site of rapidly opening blisters, covered with a purulent coating.

Atypical variety streptococcal impetigo is a simple lichen of the face or dry pyoderma, in which the skin (usually in children) appears pink spots various sizes with small scales; temporary depigmentation (discoloration of the skin) remains at the site of the resolved rashes.

Variety cystic impetigo is also superficial, in which a bubble occurs on the nail fold in an arcuate fashion around the nail at the site of burrs in case of injuries (for example, during a manicure), a needle prick, etc. When injured, such a conflict is opened and weeping erosion is formed with a large number of streptococci in the discharge.

At staphylococcal impetigo(folliculitis) in the mouths of sebaceous hair follicles, pustules (pustules) appear, reaching the size of a pea.

Folliculitis can be superficial or deep.

Superficial folliculitis is characterized by the formation of multiple small (1-2 mm, some can reach 5 mm) pustules, penetrated in the center by hair and surrounded by a narrow pink border. On the 3rd-4th day, their content dries up, yellow crusts appear, after which they fall off, no traces remain on the skin.

With deep folliculitis, painful red nodules 5 mm or more in diameter form on the skin, sometimes with an abscess in the middle. After a few days, the nodule resolves or suppurates, and then opens. After the healing of such a nodule, a scar often remains.

A combination of streptococcal and staphylococcal infections develops mixed (vulgar) impetigo, in which the contents of the bubbles are purulent, and the crusts are massive. Vulgar impetigo most often occurs on the skin of the face, less often on the trunk and extremities. Lesions are multiple. No treatment next to former rashes or new rashes appear on remote areas of the skin, the process often takes on a widespread character. When removing the crusts, a moist, eroded surface is exposed. It is important to transfer the infection to new areas through the hands and underwear. Regional lymph nodes become painful on palpation and somewhat swollen.

Complications

Most often, the disease ends without consequences, but there may be complications. One of the most unpleasant complications are complications on the kidneys (nephritis) and on the heart ().

Staphylococcal impetigo can be complicated by widespread purulent processes - abscesses and phlegmon.

Prevention

Prevention consists in the treatment of diseases that contribute to the development of impetigo, in observing the rules of personal hygiene, in treating microtraumas with antiseptic agents, sick children should not be taken to Kindergarten. In children's institutions, systematic sanitary and epidemic supervision is necessary.

Course and prognosis for impetigo

Complete recovery within 7-10 days against the background of ongoing treatment.

What can your doctor do?

The diagnosis is established on the basis of the clinical picture.

Treatment of impetigo is usually carried out in a polyclinic (outpatient).

The patient or mother (if the child is sick) is explained that the affected and adjacent areas of the skin cannot be washed with water, they should be wiped twice a day with disinfectant solutions (for example, salicylic or). Separate vesicles are opened and treated with brilliant green (brilliant green), after which an antibiotic ointment (for example, erythromycin) is applied. This treatment is carried out 3-4 times a day for 7-10 days, without applying bandages to the skin. After treatment for 1-2 weeks, the affected area is wiped with alcohol.

In severe infections in young children, they are prescribed antibiotics (by mouth or intramuscularly).

Diagnosis of impetigo is based on the isolation of the pathogen. The sampling of material for research is carried out from the bottom of the ulcer after the removal of the crust.

What can you do?

Only a doctor can assess the severity of the patient's condition and determine the amount of necessary therapeutic measures. Therefore, when the first symptoms appear, you should consult a doctor for advice in order to avoid unwanted complications.

You can not kiss with the sick, use his dishes, linen, toiletries; a child with impetigo cannot attend school, kindergarten, nursery, etc.

), which in this case do not penetrate deep into the skin.

Facts about impetigo:

• most often the disease occurs in the form of isolated cases, but epidemics can also develop, especially in children's groups;
• in 80% of cases the disease is caused by staphylococcus, in 20% by streptococcus;
• the main causative agents of impetigo, staphylococci, can cause more than 100 types of diseases, but most often affect the skin.

Features of the anatomy of the skin

The skin is made up of three words:

• Epidermis, or cuticle- outer layer. It is in contact with the external environment and protects the body from the negative effects of various factors. The epidermis consists of 5 layers of cells. The lowest one is sprout. It contains cells that are actively dividing. This is where new skin cells are formed. The newly formed cell gradually moves to the surface, through all 5 layers, eventually turns into a horny scale and disappears. This is how regular skin renewal occurs. In the epidermis there are melanocyte cells that produce the pigment melanin (which gives color to the skin), sensitive nerve endings.
• Dermis. This layer consists of connective tissue: it contains cells surrounded by intercellular substance. The dermis is responsible for the strength and elasticity of the skin, it contains blood vessels that nourish the epidermis.
• Hypodermis - subcutaneous adipose tissue. It accumulates and stores nutrients, protects the body from hypothermia.

Causes of impetigo

causative agents of the disease

• golden staphylococcus aureus;
• hemolytic streptococcus.

Factors that increase the likelihood of the disease:

• skin damage: wounds, scratches, abrasions, sores, erosion;
• shaving with a poor-quality, dull razor that injures the skin;
• skin cracks;
• scabies (scratching on the skin);
• diabetes mellitus (leads to impaired blood supply to the skin, its damage);
• reduced immunity, chronic diseases, severe infections;
• constant hypothermia, deterioration of the protective mechanisms of the skin;
• increased sweating;
• violation of personal hygiene;
• metabolic disorders, increased skin pH;
• occupational hazards: skin contact with aggressive chemicals, its pollution with various substances in the air of the production room;
• constant skin contact with lubricating oils, tar, gasoline, kerosene;
• often infection occurs in the hospital during treatment serious illnesses, after surgery: nosocomial strains of staphylococci and streptococci are resistant to antibacterial drugs, cause severe forms of impetigo and other purulent infections;
• the risk of infection is increased in young children and the elderly, in women during pregnancy, as their immune forces are reduced.

Impetigo symptoms

1. staphylococcal impetigo (ostiofolliculitis);
2. streptococcal impetigo;
3. varieties of streptococcal impetigo:
   • bullous impetigo;
   • slit-like impetigo;
   • simple deprive;
   • impetigo of the nail folds;
   • intertrigous streptoderma (diaper rash);
4. strepto-staphylococcal (vulgar) impetigo.

Staphylococcal impetigo (ostiofolliculitis)

Symptoms of the disease:

• First, there is soreness and slight redness at the base of the hair or at the location of the sweat gland.
• Then a small abscess appears in this place, usually 1-2 mm in diameter. It protrudes above the surface of the skin in the form of a cone and has a yellowish color due to translucent pus. There is swelling and redness of the skin around the abscess.
• After a few days, the abscess opens, and a small crust forms in its place, which soon disappears.
• Later, no trace remains at the site of the abscess. Sometimes the skin in this place becomes colored a little darker than around.

Sometimes an abscess with staphylococcal impetigo reaches a diameter of 1 cm. In this case, the pathology is called Bockhart's disease. Most often it is a complication of scabies. Pustules are formed in places of scratching on the back surfaces of the hands.

Streptococcal impetigo

Streptococcal impetigo symptoms:

• First, a red spot appears on the skin.
• After a few hours, a bubble 1-3 mm in diameter forms at the site of the redness area. Sometimes the bubble may appear immediately, without previous redness.
• At first, the vesicle is tense, it contains transparent contents, but later it becomes cloudy or bloody, and the vesicle itself becomes flabby.
• After opening the bubble and the discharge of pus, a gray crust remains in its place.
• After the crust falls off, a bluish-pink spot remains. Scars or other defects on the skin almost never remain.
• Recovery occurs in 3-4 weeks.

Other varieties of streptococcal impetigo

With this form of the disease, large blisters 2-3 cm in size form on the skin. After they are opened, large surface defects remain - erosion, which gradually increase in size. With bullous impetigo, the skin of the back surfaces of the hands is most often affected. In more rare cases, lesions occur in the legs and feet.

slit-like impetigo.

Another name for this disease is zaeda.

Symptoms:

• In the corner of the mouth, at the junction of the upper and lower lips, a small bubble appears.
• Then it opens, and in its place a honey-yellow crust remains, which then disappears.
• There is salivation, itching, meals become painful.

Sometimes bubbles with slit-like impetigo occur on the nose.

Factors that contribute to the occurrence and chronic course of slit-like impetigo:

This disease is often called the "dry" variety of streptococcal impetigo, in which pus does not form.

Symptoms of lichen simplex:

• Most often, the disease occurs in autumn and spring.
• Simple lichen is most common among children: epidemic outbreaks often occur in kindergartens and in elementary grades of school.
• Small oval or rounded spots form on the skin. They are white in color and clearly demarcated from the surrounding healthy skin. Peeling occurs on the affected areas.
• The patient feels itching in the lesions.
• If a person is often in the sun, then under the influence of sunlight, the spots disappear on their own. But the skin in this place tans weaker.

With simple lichen, as a rule, the skin around the mouth, in the cheeks and chin, on the trunk, on the arms and legs is affected.

Impetigo of the nail folds.

With this form of the disease, a streptococcal infection affects the skin of the nail folds located on the sides and behind the nail. Most often adults are ill.

Symptoms of impetigo nail folds:

• Usually the disease occurs after a finger skin injury, unsuccessful deburring.
• In the area of ​​​​the nail roller, small bubbles appear, filled with a clear liquid.
• Then they fill up with pus.
• There is pain, the affected finger swells.
• After the bubble is opened, a superficial skin defect remains in its place - erosion. It covers the nail in the form of a horseshoe.
• When erosion heals, recovery occurs. Sometimes there is a rejection of the nail plate.
• In some cases, the disease is severe. May develop inflammation lymphatic vessels brushes, body temperature rises, general well-being worsens.

This disease most often occurs in places where there are large folds, and two areas of the skin are constantly in contact. Sweat accumulates here, the state of the protective mechanisms of the skin is disturbed.

Places where streptococcal diaper rash most often occurs:

• Among women- under the mammary glands, especially if they are large.
• In obese people- in any large folds on the body.
• In young children: in the armpits, in the crease between the buttocks, in the inguinal folds, behind the ears, in the folds of the abdomen.

• Bubbles with a diameter of 2-3 mm appear on the skin.
• Then they merge and open. A large erosion of a bright pink color is formed, weeping occurs.
• Next to the main focus, new small bubbles appear - screenings.
• Cracks appear in the depth of the fold on the skin.
• violated general state sick. There is pain, discomfort.

Strepto-staphylococcal (vulgar) impetigo

Symptoms:

• Streptococcus bacteria penetrate the skin first. There is redness and swelling, and then a small bubble with cloudy contents appears in this place.
• After some time, a staphylococcal infection joins. The contents of the bladder turns into pus.
• Then the bubble bursts. Its contents dry up and turn into a honey-yellow crust.
• When the crust falls off, a spot remains in its place, which has a darker color compared to the surrounding skin, which subsequently disappears.
• It usually takes 8-15 days from the moment the bubble appears to the formation of a crust.
• Sometimes the pustules merge, forming larger ones. In this case, the disease is more severe.

Which doctor should I contact if I have symptoms of impetigo?

How is impetigo diagnosed?

Studies and tests that may be prescribed for impetigo:

Study title	Description	How is it carried out?
Bacteriological research	It allows you to accurately determine the pathogen that caused the infectious process in the skin, to determine its sensitivity to antibiotics.	The doctor collects pus from the blisters and sends it to the bacteriological laboratory. The material is sown on a special nutrient medium in a cup, and then studied appearance and properties of the grown colony of bacteria.
General blood analysis	An increase in the number of white blood cells (leukocytes) and an increase in the erythrocyte sedimentation rate indicate inflammatory process in the body.	Take a small amount of blood from a finger or vein.
Immunological blood tests	They are carried out with suspicion of a pronounced decrease in immunity. Usually this is indicated by the chronic course of impetigo, when relapses constantly occur after treatment.	Take blood from a vein on an empty stomach. Before the study, intensive physical exercise, smoking and drinking alcohol - because of this, the result may be distorted.
Blood chemistry	Helps to identify metabolic disorders that contribute to the emergence and maintenance of the infectious process in the skin.	For research, blood is taken from a vein on an empty stomach.
Dermatoscopy	The study is carried out in the presence of doubts in the diagnosis.	During dermatoscopy, the doctor examines the patient's skin using a special apparatus under multiple magnification.
Determining the pH (acidity level) of the skin	The study is carried out at chronic course impetigo, when the disease constantly recurs despite treatment. This may be due to an imbalance in the acidity of the skin.	To determine the pH of the skin, special glass electrodes or a color indicator are applied to it.

Impetigo treatment

Medical treatment*