Impetigos

Q: What is the correct combination of the following cutaneous findings of impetigo? - Combine answers in Set A with Set B

A) Nonbullous impetigo 

B) Bullous impetigo 

C) Ecthyma 

1) Perinasal and perioral regions

2) Truncal involvement 

3) The lower extremities 

Answer: A-1, B-2 and C-3

Systemic symptoms are usually absent in Impetigo. An astute clinician arrives at the diagnosis through examination of cutaneous lesions. One hallmark of the different types of impetigo is the area of involvement.

Nonbullous impetigo begins as vesicles with surrounding erythema. The lesions often coalesce and evolve into pustules that enlarge and rapidly break down, forming thick, adherent crusts with a characteristic golden yellow-brown or honey color. Commonly occurs at the perinasal and perioral regions. Lesions generally heal without scarring, but transient skin dyspigmentation may occur.

Bullous impetigo's vesicles enlarge to form flaccid bullae containing clear yellow fluid, which later become turbid. Ruptured bullae leave an erythematous, shiny, wet base with an overlying thin brown crust or a peripheral rim of scale, and truncal involvement is more common.

Ecthyma typically presents as circumscribed, "punched-out" ulcers with raised, violaceous or hyperpigmented margins and an overlying yellow-brown or dark-colored crust; the lower legs are the most common sites.

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References:

1. Matz H, Orion E, Wolf R. Bacterial infections: uncommon presentations. Clin Dermatol 2005; 23:503.

2. Preda-Naumescu A, Elewski B, Mayo TT. Common Cutaneous Infections: Patient Presentation, Clinical Course, and Treatment Options. Med Clin North Am 2021; 105:783.

3. Saffari PS, Lee C, Acharya H. Extensive Non-Bullous Facial Impetigo in an Adult. Vis J Emerg Med. 2023 Jul;32:101754. doi: 10.1016/j.visj.2023.101754. Epub 2023 Jun 22. PMID: 37901479; PMCID: PMC10601362.

4. Brazel M, Desai A, Are A, Motaparthi K. Staphylococcal Scalded Skin Syndrome and Bullous Impetigo. Medicina (Kaunas). 2021 Oct 24;57(11):1157. doi: 10.3390/medicina57111157. PMID: 34833375; PMCID: PMC8623226.

5. Lau WC, Yang K, Lau CB, Pan CX, Kassamali B, Nambudiri VE. Clinicopathologic features of ecthyma gangrenosum: a single integrated health system cohort. Arch Dermatol Res. 2023 Nov;315(9):2717-2719. doi: 10.1007/s00403-023-02655-w. Epub 2023 Jul 11. PMID: 37432465.