Vulgar impetigo is a contagious skin disease from the group of pyococcal (pustular) infections. Occurs most often in children, but can affect adults who neglect the rules of personal hygiene. It is clinically manifested by a pustular rash on unchanged skin, with combs, erosions, crusts, which tends to peripheral growth, the formation of dropout foci. Pustules occur in places of violation of the skin (cracks, abrasions, cuts). The diagnosis is made on the basis of the clinic, taking into account the clinical and laboratory examination (blood test, biochemistry, acidity of the skin surface, dermatoscopy). The treatment is antibacterial, it is important to observe the norms of personal hygiene.
Vulgar impetigo is a contagious variety of acute, superficial pustular eruptions of mixed (staphylococcal-streptococcal) etiology. The disease has no age, sex, race, seasonal differences; it does not have endemic. Vulgar impetigo accounts for about 10% of modern skin pathology. Even the doctors of ancient Rome widely used the term “impetigo” in relation to all skin lesions with purulent crusts on the surface. In 1798, the English doctor Villan and his student Batman managed to combine a variety of skin rashes into 9 classes corresponding to the primary elements of skin manifestations, while taking impetigo to the class of pustules. In 1800, the French dermatologist Alibert clarified the color of the rashes, calling them “golden-honey aggressors”. In 1841 Tilbury Fox, a representative of the Vienna School of Dermatology, proved the contagiousness of pathology. The discovery of the mechanism of pus formation, the development of a technique for cultivating pyococci gave the key to a correct understanding of the essence of impetigo, diagnosis and treatment. The relevance of the disease is due to its contagiousness.
The cause of superficial skin infection is the microbial association of Staphylococcus and streptococcus. The prevalence of vulgar impetigo is due to the wide presence of these pathogens in nature. Normally, the skin is a habitual habitat for microbes of this group. Performing its main functions – barrier and protection – the skin prevents their penetration into the patient’s body. This is the first line of non–specific defense of the body against pathogens. When washing, a huge number of microbes are removed along with the horny scales of the epidermis. On the mucous membranes, the function of a “tow truck” is performed by the atrial fibrillation epithelium. Supports the aseptic state of the dermis pH (from 3 to 5), lactic acid produced by sweat glands, normal microflora of the skin. The bactericidal properties of the epidermis are due to the presence on its surface of lysozyme, immunoglobulins IgA, IgM, responsible for local immunity, blocking staphylococci and streptococci on the surface of the skin.
However, it is necessary to violate the integrity of the skin (abrasion, scratch, maceration), neglect the rules of personal hygiene, change the pH of the skin due to overheating or hypothermia, as strepto-staphylococcal infection will rush deep into the dermis, causing skin manifestations of the disease. Stress, intoxication, hypovitaminosis, exacerbation of chronic infections, somatic diseases can facilitate the penetration of microorganisms. There is no natural immunity against impetigo. During the development of the infectious process, unstable, short-term cellular-humoral immunity occurs, affecting the prevalence, severity of skin pathology, contributing to the sensitization of the dermis.
Impetigo does not belong to the group of dangerous infections, regresses most often on its own, but it can cause damage to internal organs, and due to extreme contagiousness, it causes an epidemic in closed collectives (family, kindergartens, schools, barracks), which makes it treated with increased caution. Sometimes vulgar impetigo develops against the background of itchy dermatoses with epidermis-damaging combs (neurodermatitis, scabies).
Clinical manifestations of vulgar impetigo are associated with the fact that staphylococcus (golden, white) affects the appendages of the skin; streptococcus (hemolytic) causes the formation of bubbles (flicken) on its surface. The combination of these symptoms gives a complete, three-dimensional picture of the pathology. The disease begins acutely: on the moderately hyperemic surface of the skin of the face, a pustular rash appears around the natural openings – flickens filled with serous contents. Very quickly, the liquid becomes cloudy due to the addition of a secondary infection, shrinks into honey-yellow crusts with a dusty hue, which are a distinctive clinical sign of vulgar impetigo.
A chronic course of the disease is also possible, since blistering rashes tend to peripheral growth, the seizure of new areas of the skin, forming so-called “dropout foci”. In parallel, new flictenes arise, leaving erosions, bloody-purulent crusts when opened. Hair follicles and the mouths of sweat glands are involved in the process. Due to increased sebum and sweating, an unpleasant smell, a sloppy appearance of the scalp appears. Each bubble exists on the skin for seven days, after which the “greasy” crust disappears, leaving a small pink pigmentation that disappears in a couple of weeks.
The combination of symptoms of streptococcal and staphylococcal infection in the clinic of the disease does not cause difficulties in the diagnosis of impetigo. Helps in this blood test (leukocytosis and increased ESR), biochemistry (the ratio of protein fractions of blood, blood sugar and urine), determination of the acidity of the skin surface (pH), bakisledovanie (sowing purulent discharge of pustules to determine the sensitivity of cocci to antibiotics), dermatoscopy (assessment of changes in the structure of the skin and the nature of its lesion). If necessary (in case of severe course with a tendency to deep dermis damage), an immunogram is performed (assessment of the patient’s immune status), histology of the lesion is performed with subsequent consultations of an endocrinologist, neurologist, surgeon. Differentiate with other varieties of impetigo, pyoderma, herpes.
Treatment and prevention
Etiopathogenetic therapy is primarily antibacterial. Since vulgar impetigo is a superficial lesion of the skin, you can limit yourself to external means: after opening the pustules, 2% salicylic acid, 1% alcohol solution of fucorcine, brilliant green, methylene blue is applied to the hearth and the skin around it. With resistance, ointments with antibiotics (2%-3%), miramistin, a combination of antibiotics and hormones (hydrocortisone + oxytetracycline) are added to the therapy. A course of vitamin therapy (B, C), immunostimulants (echinacea juice), UFOs is indicated. A common process resistant to external therapy requires a course of tableted or injectable antibiotics (erythromycin) in combination with eubiotic drugs. However, the main thing in the treatment of vulgar impetigo is compliance with the rules of personal hygiene; regular skin care.
Compliance with the sanitary and hygienic rules of the hostel and personal hygiene, lack of contact with the sick, strengthening of immunity, proper nutrition (restriction of sweets, consumption of foods with a high content of vitamin C, a sufficient amount of proteins) is the prevention of vulgar impetigo. But if an infection has arisen, for a speedy recovery, it is necessary to regularly carry out wet cleaning of premises with an antiseptic, use a separate towel, bed linen, dishes, do not rub the skin when bathing, treat microtrauma with an antiseptic. A sick child cannot attend school or kindergarten. The prognosis is favorable, vulgar impetigo is well treated, rarely complicated.