A 3-Year-Old Boy with an Erythematous, Infiltrated Plaque on the Occipital Area

Abstract

Impetigo contagiosa is an acute bacterial infection. It is most commonly observed in children, between 2 and 5 years of age. The disease is highly contagious and primarily caused by Staphylococcus aureus or Streptococcus pyogenes. Impetigo is distinguished as either non-bullous (70% of all cases) and bullous (30% of cases). Nonbullous impetigo contagiosa is characterized by honey-colored crusts on erythematous background localized most commonly on the face and extremities. Mild regional lymphadenopathy commonly occurs, but systemic symptoms are rarely observed. Mucous membranes are not affected. Bullous impetigo contagiosa is characterized by the presence of small vesicles, which becomes flaccid bullae. They contain a clear or yellow fluid which eventually progresses to become purulent. Once the bullae rupture, an erythematous base with a rim of scale is observed. Bullous impetigo contagiosa tends to be less contagious. Lesions besides face and extremities, are localized on the armpits, trunk, and perianal region. Buccal mucous membranes may be also affected. Regional lymphadenopathy is rarely presented. Systemic symptoms, such as fever, are more common compared to nonbullous impetigo. The diagnosis of impetigo contagiosa is usually based on the clinical picture. Impetigo contagiosa is most commonly treated with topical antibiotics such as mupirocin, retapamulin, and fusidic acid. Systemic beta-lactamase-resistant antibiotics such as cephalosporins, amoxicillin-clavulanate, dicloxacillin may be also recommended.