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Bullous impetigo
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
Bullous impetigo is a skin infection caused by toxin-producing strains of Staphylococcus aureus and is the localized form of staphylococcal scalded-skin syndrome. Erythematous vesicles rapidly progress to large flaccid superficial bullae. Systemic symptoms are uncommon. Bullous impetigo is most common in neonates and is often found in intertriginous areas, such as the diaper region, neck, and skin folds.
Dermatology
Published in Fazal-I-Akbar Danish, Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Blisters/erosions in a child/young adult:1 Pemphigoid (PG).2 DH.3 Chicken pox.4 Bullous impetigo (exclusively in children).5 SSSS (exclusively in children).
Case 74: A Blistering Rash
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
Bullous impetigo, usually caused by Staphylococcus aureus, is a fairly common infectious skin condition. Infections are more common in children, immunosuppressed people and those who work in institutions such as hospitals or schools.
A comparative review of current topical antibiotics for impetigo
Published in Expert Opinion on Drug Safety, 2021
Eugenio Galindo, Adelaide A Hebert
Impetigo is one of the most common pediatric dermatoses caused by bacterial infection of the epidermis. This infection predominantly affects pre-school and school-aged children ages 2 to 6 years of age, although adults can be affected as well. Globally estimates suggest that this disease affects 162 million children at a single moment [1,2]. Impetigo can be present in bullous or nonbullous forms. Nonbullous impetigo is more common (approximately 70% of cases) [3] and can be due to pathogens S. aureus and S. pyogenes. The classic primary lesion is manifested with pustules that form a yellow-golden crust, often localized around the nose and mouth or the extremities. Bullous impetigo is caused exclusively by S. aureus and presents with large superficial bullae with yellow fluid caused by bacterial toxins [3]. While the infection is considered ‘self-limiting,’ treatment is recommended to prevent spread of this contagious disease. School aged children often require isolation from school, work or activities and thus, early detection and prompt treatment remain paramount. Treatment of impetigo can range from use of topical disinfectants to topical or oral antibiotics. The treatment of choice for usually depends on the severity of the infection and experience of the prescribing clinician. In the past decade, increasing resistance rates to all antibiotics, including topical agents, remain a concern [2,4,5]. Currently the list of FDA-approved topical antibiotics includes Mupirocin, Retapamulin, and most recently Ozenoxacin. Outside of the United States, Fusidic Acid is approved in countries such as Europe, Australia, and parts of Asia.
Tocilizumab Employment in the Treatment of Resistant Juvenile Idiopathic Arthritis Associated Uveitis
Published in Ocular Immunology and Inflammation, 2021
Arash Maleki, Ambika Manhapra, Soheila Asgari, Peter Y. Chang, C. Stephen Foster, Stephen D. Anesi
In comparison with the Calvo-Rio et al. study,27 we observed a lower success rate despite following almost the same protocol for IV-TCZ employment. This could be attributed to the fact that while patients in the Calvo-Rio study were allowed to be on an oral corticosteroid treatment even at 6 months, patients in our study were considered as treatment failure if they were or needed to be on any type of corticosteroid therapy after 3 months of IV-TCZ employment. Moreover, in their study, it is not clear whether they considered anyone who stopped medication due to side effects a treatment failure. We did not observe any side effects in our study and this does not change our success rate. Considering Simon’s two-stage design, both studies support a phase 3 trial for IV-TCZ employment in the treatment of JIA associated uveitis. Calvo-Rio et al.27 reported pneumonia, thrombocytopenia, hemolytic anemia, viral conjunctivitis and bullous impetigo in their case series. These side effects justify close follow up of patients on IV-TCZ therapy. The lack of side effects in our case series may be explained by minor dose adjustments of IV-TCZ before each infusion based on any abnormal or concerning high risk blood lab results, which includes CBC monitoring (especially WBC), LFT, BUN, and Cr. More noted side effects in the Calvo-Rio et al study may be related to more frequent infusions (every two weeks) in some of their patients; however, it is not clear in their study if these patients on more frequent infusions had these side effects. In addition, our small sample size may contribute to our absence of side effects. (Table 4)
Formaldehyde as an alternative to antibiotics for treatment of refractory impetigo and other infectious skin diseases
Published in Expert Review of Anti-infective Therapy, 2019
Philip Nikolic, Poonam Mudgil, John Whitehall
Impetigo presents in three main forms and is primarily caused by S. aureus. The first, called non-bullous impetigo presents as a maculopapular lesion that becomes a thin-walled vesicle. The vesicle ruptures and dries as a yellowish crust. The second presentation, called bullous impetigo presents as small vesicles at first that then become localized blisters. These blisters do not rupture as easily as the vesicles in non-bullous impetigo. The final presentation of impetigo is called ecthyma. Ecthyma extends further into the dermis layer than the other two forms and is characterized by vesicles that rupture producing circular ulcers with black-brown crusts. All three forms can also be caused by S. pyogenes but this is less common [42].