Streptococcal impetigo (contagious impetigo) is a contagious skin disease of streptococcal etiology, manifested by a rash in the form of small bubbles (flickten) with a hyperemic edematous base. Bubbles tend to increase and merge, after their resolution, pinkish spots remain on the skin for a while. Diagnosis of streptococcal impetigo includes examination, dermatoscopy, skin pH examination and bacposev of the separated flicken. If necessary, immunological studies are carried out. Treatment consists in careful treatment of the affected areas with disinfectants, the application of ointments with antibiotics. Given the high contagiousness of streptococcal impetigo, isolation of the patient is required until his full clinical recovery.
Streptococcal impetigo occurs mainly in children and in women with delicate sensitive skin. Children with reduced immunity and a tendency to diathesis are most often affected by the disease. The high contagiousness of streptococcal impetigo contributes to the rapid spread of the disease in the children’s collective (1-2 days), for which it received the popular name “flint”.
In dermatology, the concept of streptococcal impetigo includes several clinical varieties united by a single etiological factor and the presence of typical rash elements — flicken. Streptococcal impetigo includes: bullous, ring-shaped and slit-shaped impetigo (cheilitis), impetigo of nail rollers (tumor), streptococcal diaper rash, posterosive syphilis.
The cause of the disease is streptococcal infection. In a small part of the sick, staphylococci are sown. Infection occurs by contact through infected hands, common items, clothing, toys, etc. The penetration of infection through the skin and mucous membranes becomes possible if their integrity is violated. Most often, these are microtrauma and skin scratching accompanying itchy dermatoses (atopic dermatitis, eczema, pruritus, allergic contact dermatitis), as well as maceration of the skin during overheating, excessive sweating, the presence of rhinitis or otitis with abundant secretions. The development of streptococcal impetigo is facilitated by contamination of the skin, a change in its pH, and a decrease in the body’s resistance.
Streptococcal impetigo begins with the appearance of small red spots on the skin, which quickly, within a few hours, turn into flickens — small bubbles located on a red edematous base. At first, the bubbles are tense and have transparent contents. Then they become sluggish, the liquid inside them becomes cloudy, turning into pus. Over time, the flickens either dry out, forming brownish or yellowish-gray crusts, or open up, exposing erosion covered with a purulent coating. The plaque dries and transforms into yellow crusts, under which erosion heals. After the crusts disappear, a temporary pink-lilac spot remains on the skin. The whole process from the appearance to the resolution of the flick takes about a week.
Streptococcal impetigo rashes are usually localized on the face, lateral surfaces of the limbs and trunk. Flictenes are located separately, but due to peripheral growth they often merge. Self-infection leads to a rapid spread of the process to healthy areas of the skin. But with adequate treatment and care, the disease lasts no more than a month and passes without leaving any scars or hyperpigmentation.
Streptococcal impetigo is diagnosed by a dermatologist based on characteristic clinical signs. Dermatoscopy and skin pH examination are performed. To confirm the streptococcal etiology of the disease, a back-sowing of the separated flicken is necessary. Often recurrent forms of streptococcal impetigo require an immunological examination of the patient to detect disorders in the immune system.
Disease should be differentiated from folliculitis, ostiofolliculitis, vulgar impetigo, bullous form of simple contact dermatitis, allergic contact dermatitis, bullous dermatitis: epidemic pemphigus of newborns, herpes simplex, herpetiform dermatitis of During.
Treatment and prevention
Streptococcal impetigo therapy corresponds to the general principles of streptodermia treatment and is carried out mainly with local disinfectants and antibacterial agents. Single flictenes are treated with solutions of aniline dyes: diamond green, fucarcin, etc. When crusts are formed, bandages with streptocide, white mercury or boron-naphthalan ointment are used. Effective external use of antibacterial ointments with neomycin, oxytetracycline and hormonal agents with hydrocortisone, flumetazone, prednisone. Resorcinol lotions are applied to large areas of the lesion with a pronounced inflammatory reaction.
Treatment of impetigo nail rollers is carried out with the use of antibiotics. In some cases, surgical treatment is necessary. Systemic antibiotic therapy is also indicated for severe or often recurrent variants of streptococcal impetigo. In such cases, it is carried out against the background of restorative treatment.
Prevention includes timely change of linen, hygiene, treatment of damaged areas of the skin with disinfectant solutions. To prevent the spread of infection, patients are isolated.