Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.
Impetigo is a gram-positive bacterial infection of the superficial layers of the epidermis. There are two forms of impetigo: bullous and nonbullous. Diagnosis of impetigo is usually based solely on the history and clinical presentation. Culture and sensitivity results can help the physician choose appropriate antibiotic therapy. Treatment of impetigo typically involves local wound care, along with antibiotic therapy, either topical alone or in conjunction with systemic therapy. For mild or localized cases, topical mupirocin or topical fusidic acid applied 2 to 3 times daily for 7 to 10 days are adequate treatment. Systemic antibiotics are indicated for widespread, complicated, or severe cases associated with systemic manifestations of impetigo. Beta-lactam antibiotics remain an appropriate initial empiric choice, with coverage against both Staphylococcus aureus and Streptococcus pyogenes. For patients with recurrent impetigo or Staphylococcus aureus nasal carriers, topical mupirocin cream or ointment can be applied inside the nostrils 3 times daily for 5 days each month to reduce colonization in the nose.
Keywords: Impetigo, Staphylococcus aureus, Group A beta hemolytic streptococci Bullous impetigo, Nonbullous impetigo.