INTRODUCTION
Impetigo is a highly contagious bacterial infection involving the superficial skin, primarily due to S. aureus, less frequently S. pyogenes, or both. It occurs most frequently in children ages two to six year but may affect younger and older children and adults as well. Self-inoculation and small family or communities outbreaks are common. There are more than 3 million cases of impetigo in the United States every year.1 Impetigo may be classified as a primary (direct bacterial invasion of an intact skin) or secondary infection of pre-existing skin disease or traumatized skin (atopic dermatitis, scabies, cuts, abrasions, insect bites, and chickenpox)2,3 Secondary impetigo is sometimes referred to as "impetiginization."
Two clinical forms of impetigo are recognized: (1) nonbullous and (2) bullous. The nonbullous type (also known as impetigo contagiosa) is the most common and accounts for around 70% of cases and in the industrialized world is caused by mainly by S. aureus.2 However, S. pyogenes remains a common cause of nonbullous impetigo in developing nations. Clinically, nonbullous impetigo presents as erythematous pustules or vesicles (red sores) that quickly evolve into superficial erosions with a characteristic "honey-colored" crusts. Lesions usually involve the face, around the nose and mouth, but can be seen on extremities and trunk. The lesions are often smaller than 2 cm, not or minimally painful and without erythema or constitutional symptoms, although regional adenopathy may be present.1,2 More severe forms of impetigo may be associated with pruritus, erythema, crusted erosions, fissures, and odor. Bullous impetigo is less common, usually intertriginous areas, and is caused by strains of S. aureus that produce exfoliative
Two clinical forms of impetigo are recognized: (1) nonbullous and (2) bullous. The nonbullous type (also known as impetigo contagiosa) is the most common and accounts for around 70% of cases and in the industrialized world is caused by mainly by S. aureus.2 However, S. pyogenes remains a common cause of nonbullous impetigo in developing nations. Clinically, nonbullous impetigo presents as erythematous pustules or vesicles (red sores) that quickly evolve into superficial erosions with a characteristic "honey-colored" crusts. Lesions usually involve the face, around the nose and mouth, but can be seen on extremities and trunk. The lesions are often smaller than 2 cm, not or minimally painful and without erythema or constitutional symptoms, although regional adenopathy may be present.1,2 More severe forms of impetigo may be associated with pruritus, erythema, crusted erosions, fissures, and odor. Bullous impetigo is less common, usually intertriginous areas, and is caused by strains of S. aureus that produce exfoliative
