guidelines. Well-designed algorithms have inputs and outputs, are precise, and have uniquely defined steps. The algorithm stops after a finite number of instructions.18 For the development of the impetigo treatment algorithm, the unpublished mnemonic RECUR (Reliable, Efficient, Clear instructions, Understandable, Remember easily) was used.
The algorithm has the following steps: Education and prevention of impetigo, diagnosis and classification, treatment measures, and follow-up (Figure 2A and Figure 2B).
Education and Prevention of Impetigo
Education on risk factors for impetigo development is an important part of the total approach. These risk factors are a warm, humid climate, poverty, crowding, poor hygiene, and underlying scabies.1 Impetigo may be spread in children through pets, in schools, daycare centers, or crowded housing areas; for adults, sources include infected children and selfinoculation from nasal or perineal carriage.1 Carriage of group A Streptococcus (GAS; S. pyogenes) and S. aureus predisposes to subsequent impetigo.4
Diagnosis and Classification
Non-bullous impetigo frequently presents on the face around the nose and mouth with erythematous pustules or vesicles changing to superficial erosions with a characteristic "honey-colored" crust.1,5 Lesions can also occur elsewhere on the body and are usually smaller than 2 cm and not or minimally painful. Frequently impetigo occurs without remarkable erythema or constitutional symptoms, although regional adenopathy may be present.1,5
Bullous impetigo is caused by strains of S. aureus that produce toxin A which induces a loss of cell adhesion in superficial epidermal layers by targeting protein desmoglein-1.5,6
Bullous impetigo lesions are usually large, transparent superficial bullae before rupturing, leaving round erosions that become crusted. Bullous impetigo frequently occurs in intertriginous areas and the trunk.6
Impetigo is either 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). Secondary impetigo is also called impetiginization.
There is an ongoing discussion regarding the definition of localized impetigo, which varies from five to ten lesions and an affected area smaller than 50 cm2 up to 100 cm2.10
Clinical trials of ozenoxacin, retapamulin, and mupirocin defined
The algorithm has the following steps: Education and prevention of impetigo, diagnosis and classification, treatment measures, and follow-up (Figure 2A and Figure 2B).
Education and Prevention of Impetigo
Education on risk factors for impetigo development is an important part of the total approach. These risk factors are a warm, humid climate, poverty, crowding, poor hygiene, and underlying scabies.1 Impetigo may be spread in children through pets, in schools, daycare centers, or crowded housing areas; for adults, sources include infected children and selfinoculation from nasal or perineal carriage.1 Carriage of group A Streptococcus (GAS; S. pyogenes) and S. aureus predisposes to subsequent impetigo.4
Diagnosis and Classification
Non-bullous impetigo frequently presents on the face around the nose and mouth with erythematous pustules or vesicles changing to superficial erosions with a characteristic "honey-colored" crust.1,5 Lesions can also occur elsewhere on the body and are usually smaller than 2 cm and not or minimally painful. Frequently impetigo occurs without remarkable erythema or constitutional symptoms, although regional adenopathy may be present.1,5
Bullous impetigo is caused by strains of S. aureus that produce toxin A which induces a loss of cell adhesion in superficial epidermal layers by targeting protein desmoglein-1.5,6
Bullous impetigo lesions are usually large, transparent superficial bullae before rupturing, leaving round erosions that become crusted. Bullous impetigo frequently occurs in intertriginous areas and the trunk.6
Impetigo is either 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). Secondary impetigo is also called impetiginization.
There is an ongoing discussion regarding the definition of localized impetigo, which varies from five to ten lesions and an affected area smaller than 50 cm2 up to 100 cm2.10
Clinical trials of ozenoxacin, retapamulin, and mupirocin defined
