eMedicine Specialties > Infectious Diseases > Skin and Soft-Tissue Infections

Impetigo: Follow-up

Author: John Ratz, MD, MBA, Staff Dermatologist, Mohs Surgeon, Center for Dermatology and Skin Surgery, Inc
Coauthor(s): Daniel B Ward Jr, MD, Clinical Assistant Professor, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Nov 5, 2009

Follow-up

Further Outpatient Care

  • Follow-up is important to ensure complete clearing of lesions. Request that patients schedule follow-up visits if lesions worsen or do not improve after beginning therapy.

Complications

  • Acute poststreptococcal glomerulonephritis
    • Acute poststreptococcal glomerulonephritis (AGN) is a rare but potential complication of nonbullous impetigo.
    • It occurs in less than 1% of cases, depending on the nephritogenic potential of the S pyogenes strain involved. Many strains have no nephritogenic potential, but types M-60 and M-49 cause AGN in 70% and 25% (respectively) of patients with impetigo caused by these strains.
    • Interestingly, in certain tropical and subtropical climates, skin infection is the most common infection preceding nephritis. Rheumatic fever, however, is not a risk following streptococcal impetigo because it develops after streptococcal pharyngitis. Use anti-DNAse B, antihyaluronidase, and ASO titers to provide evidence of a recent streptococcal infection.
  • Other complications (rare)
  • Untreated lesions may progress to ecthyma.

Prognosis

  • With appropriate treatment, lesions usually heal in 2-3 weeks or less; however, patients with eczema or an underlying parasitic infection may have a prolonged course.
  • Patients typically do not have scars, but postinflammatory pigment alterations may occur.

Patient Education

Miscellaneous

Special Concerns

  • Impetigo may become endemic or epidemic in certain populations during the summer months. Consider antibiotic prophylaxis in these populations.
 


More on Impetigo

Overview: Impetigo
Differential Diagnoses & Workup: Impetigo
Treatment & Medication: Impetigo
Follow-up: Impetigo
Multimedia: Impetigo
References
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References

  1. Ludlam H, Cookson B. Scrum kidney: epidemic pyoderma caused by a nephritogenic Streptococcus pyogenes in a rugby team. Lancet. Aug 9 1986;2(8502):331-3. [Medline].

  2. Cunha BA. Antibiotic Essentials. Royal Oak, Mich: Physicians Press:2005.

  3. Dajani AS, Ferrieri P, Wannamaker L. Endemic superficial pyoderma in children. Arch Dermatol. Oct 1973;108(4):517-22. [Medline].

  4. Dajani AS, Ferrieri P, Wannamaker LW. Natural history of impetigo. II. Etiologic agents and bacterial interactions. J Clin Invest. Nov 1972;51(11):2863-71. [Medline].

  5. Dillon HC Jr. Topical and systemic therapy for pyodermas. Int J Dermatol. Oct 1980;DA - 19810424(8):443-51. [Medline].

  6. Drug Information for the Health Care Professional. USP DI-Volume I. 17th ed. Chicago, Ill: Rand McNally; 1997.

  7. el Tayeb SH, Nasr EM, Sattallah AS. Streptococcal impetigo and acute glomerulonephritis in children in Cairo. Br J Dermatol. Jan 1978;98(1):53-62. [Medline].

  8. Elias PM, Levy SW. Bullous impetigo. Occurrence of localized scalded skin syndrome in an adult. Arch Dermatol. Jun 1976;112(6):856-8. [Medline].

  9. Ferrieri P, Dajani AS, Wannamaker LW, et al. Natural history of impetigo. I. Site sequence of acquisition and familial patterns of spread of cutaneous streptococci. J Clin Invest. Nov 1972;51(11):2851-62. [Medline].

  10. Ginsburg CM. Staphylococcal toxin syndromes. Pediatr Infect Dis J. Apr 1991;10(4):319-21. [Medline].

  11. Hay RJ, Adriaans BM. Bacterial Infections. In: Champion RH, Breathnach SM, Burns AD, et al, eds. Textbook of Dermatology. 6th ed. Oxford, England: Blackwell Science; 1998:1097-1179.

  12. Hirschmann JV. Bacterial infections of the skin. In: Sams WM Jr, Lynch PJ, eds. Principles and Practice of Dermatology. 2nd ed. New York, NY: Churchill Livingstone; 1993:79-88.

  13. Hirschmann JV. Topical antibiotics in dermatology. Arch Dermatol. Nov 1988;124(11):1691-700. [Medline].

  14. Kahn RM, Goldstein EJ. Common bacterial skin infections. Diagnostic clues and therapeutic options. Postgrad Med. May 1 1993;93(6):175-82. [Medline].

  15. Lee PK, Weinberg AN, Swartz MN, et al. Pyodermas: Staphylococcus aureus, Streptococcus, and Other Gram-Positive Bacteria. In: Fitzpatrick TB, Eisen AZ, Wolff K, et al, eds. Dermatology in General Medicine. 4th ed. New York, NY: McGraw-Hill; 1999:2182-2207.

  16. Mertz PM, Marshall DA, Eaglstein WH, et al. Topical mupirocin treatment of impetigo is equal to oral erythromycin therapy. Arch Dermatol. Aug 1989;125(8):1069-73. [Medline].

  17. Rice TD, Duggan AK, DeAngelis C. Cost-effectiveness of erythromycin versus mupirocin for the treatment of impetigo in children. Pediatrics. Feb 1992;89(2):210-4. [Medline].

  18. Scales JW, Fleischer AB Jr, Krowchuk DP. Bullous impetigo. Arch Pediatr Adolesc Med. Nov 1997;151(11):1168-9. [Medline].

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Further Reading

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Keywords

impetigo, skin infection, cutaneous infection, bullous impetigo, nonbullous impetigo, Staphylococcus aureus, S aureus, Streptococcus pyogenes, S pyogenes, group A Streptococcus, GAS, group A streptococci, streptococci, staphylococci

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Contributor Information and Disclosures

Author

John Ratz, MD, MBA, Staff Dermatologist, Mohs Surgeon, Center for Dermatology and Skin Surgery, Inc
John Ratz, MD, MBA is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physicians, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, International Society for Dermatologic Surgery, and Southern Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Daniel B Ward Jr, MD, Clinical Assistant Professor, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina
Daniel B Ward Jr, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Gregory William Rutecki, MD, Associate Professor, Program Director, Department of Internal Medicine, Feinberg School of Medicine, Northwestern University
Gregory William Rutecki, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Nephrology, National Kidney Foundation, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gordon L Woods, MD, Consulting Staff, Department of Internal Medicine, University Medical Center
Gordon L Woods, MD is a member of the following medical societies: Society of General Internal Medicine
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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