When adults and more commonly children, fail to follow proper wound care after any kind of skin injury occurs, it could lead to infectious processes affecting the skin.
Impetigo is one such contagious skin problem that develops when skin becomes damaged either due to scrapes, bruises, insect bites, or minor cuts. The bacterial infection first starts off as small pimple like skin elevations, which turn into fluid-filled cysts that rupture, leading to thick crust formation usually honey colored. Skin areas that are exposed, like the limbs and facial areas are usually involved in the development of this communicable skin infection.
Impetigo has two variants – the bullous and the non-bullous type. While the non-bullous type is more common, the bullous variant is considered to be the rarest of both.
Bullous impetigo is called so because it presents with a large blister or vesicle. This type can affect even normal skin, that has no cuts or bruises for the bacteria to enter. Impetigo of this type is more commonly seen in infants below 5 years of age. The skin infection is caused by the staphylococcus aureus bacterial strain that releases toxins causing the skin to exfoliate. The blisters formed also will be very fragile and not so firm. The release of toxins is restricted to the infection area only though, that lowers the adhesive ability of the skin, thereby separating the top layer of skin (epidermis) from the layer lying beneath it, known as – the dermis. The tiny fluid-filled pouches begin to enlarge in size very rapidly and form into a large blister, bigger than 5 mm in size. And, because this condition causes the sloughing of top layer of skin, there is extreme skin loss noted as well.
Symptoms of Bullous Impetigo
– Swollen glands, especially of those connected to the immune system
– Fever and chills
– Loose stools
– Sometimes pain may be felt, though this is a very rare occurrence
Treatment for Bullous Impetigo
The first line of treatment will involve the use of antibiotic applicants to reduce its spread from individual to individual. For the treatment to be effective, cream application should be done only after cleansing the wounds and gently removing any scabs formed, for its deeper penetration into the skin.
Topical antibiotic creams usually prescribed are fusidic acid and mupirocin. However, in the case of fusidic acid use, the bacteria will develop resistance to it very early into the treatment process, making its use rather ineffective.
Mupirocin on the other hand, is considered to be far more superior to fusidic acid in terms of killing the bacteria causing the infection in an effective manner, without much bacterial resistance noted.
Generally, along with topical applications, a course of oral antibiotics too will be needed to treat bullous impetigo type, for the infection tends to last for a long period of time. The choice of antibiotic pill in this case is usually flucloxacillin, to be taken for a seven day period, and the course must be finished even if symptoms seem to improve.
In severe cases, where large skin areas are involved, intravenous fluid revitalization will be required. The administration of fluid will be at a rate and volume similar to those used while treating skin burns.
Since, most often the patient suffering from this type of impetigo will turn out to be an infant, isolating the child from others, to prevent skin contact and disease spread, is done.