The purpose of this discussion is to review impetigo. Impetigo can be mistaken for other skin conditions such as herpes simplex. Therefore, it is necessary to accurately identify what it is. Impetigo is a skin disorder that is superficial in nature. It can spread from person to person and on other parts of the body (Centers for Disease Control and Prevention [CDC], 2020).
The main form of transmission is direct contact. The infection is caused by bacteria (CDC, 2020). Staphylococcus aureus is the main causative agent in older children. Group A beta-hemolytic streptococci also causes impetigo (Hubert & VanMeter, 2018). Interruption in the skin barrier allows the bacteria to access fibronectin receptors in the skin, which is needed for colonization (Nardi & Schaefer, 2020). Infection is further spread by itching due to the irritable nature of the lesions. Autoinoculation with hand creates more vesicles (Hubert & VanMeter, 2018).
The Most Common Presenting Symptoms
Impetigo can be found on any part of the body (CDC, 2020). However, it is mostly seen on the face (Hubert & VanMeter, 2018). Small red vesicles quickly become larger. The vesicles break open and forms a yellowish-brown crust. Liquid with honey colored appearance is seen under the crusts (Hubert & VanMeter, 2018).
Impetigo is diagnosed by initial observation of an abnormality in the skin during a physical exam. The diagnosis can be confirmed with a bacterial culture, especially if there is an epidemic or if methicillin-resistant staph aureus (MRSA) is a concern. A biopsy of the skin can be obtained in some cases of untreatable impetigo (Nardi & Schaefer, 2020). Serologic testing for streptococcus antibodies is not done since anti-streptolysin O (ASO) response is not strong enough for diagnosing impetigo in this manner. Nonetheless, it can be used in conditions where
post-streptococcal glomerulonephritis is questioned for patients who had a new outbreak of impetigo (Nardi & Schaefer, 2020). Otherwise lab testing is not needed (CDC, 2020).
Standard Treatment Plan
Impetigo is managed with antibiotics since it is a bacterial infection. Administration of antibiotic drugs is needed in cases where the infection is extensive. Otherwise the topical cream is prescribed when the infection is in a mild state (Hubert & VanMeter, 2018). If left untreated, the infection will resolve on its own. However, treatment with antibiotics decreases complications (Nardi & Schaefer, 2020). Prior to applying topical antibiotic cream, soap and water should be used to remove the crust. The treatment of choice with antibiotic cream are mupirocin, retapamulin, and fusidic acid. Otherwise, preferred treatment with systemic antibiotics are amoxicillin-clavulanate, cephalosporins, dicloxacillin (Nardi & Schaefer, 2020).
Link(s) to Routine Screening and Treatment Guidelines
National screening guidelines for impetigo was not found. However important facts that can benefit both patient and the Advanced Practice Registered Nurse (APRN) are provided in the link below. https://www.health.nsw.gov.au/Infectious/factsheets/Pages/impetigo.aspx
Additionally, Kwak et al. (2017) provided a detailed summary of recommendations for skin and soft tissue infection including impetigo, which can be accessed in the reference.
Treatment guidelines for impetigo is provided in the link below. Clinical features are included.
Atopic dermatitis, or eczema, is a chronic disease that causes skin inflammation, erythema, and extreme pruritus. It is a common disease that usually appears in babies and children and resolves before the teenage years, but anyone can get it, and some adults continue to have symptoms (NIAMS, 2019). Although from appearance it looks like it could be spread from person to person contact, atopic dermatitis is not contagious. No one knows what causes atopic dermatitis, but it seems to have a genetic component. Treatment can help control symptoms, but depending on severity of symptoms, living with the disease may be hard for some (NIAMS, 2019).
The pathogenesis of atopic dermatitis is not entirely understood, but there appears to be a link between defects in “skin barrier function, immune dysregulation, and environmental and infectious agents” (Kapur et al, 2019). In individuals with atopic dermatitis, defective immune responses may contribute to susceptibility to increased bacterial and viral infections; the infectious agent most often seen is Staphylococcus aureus (Kapur et al, 2019).
Signs and Symptoms
Incessant pruritus is the main and most debilitating symptom and diagnosis of atopic dermatitis (Kim, 2020) . The extreme itchiness is worse at night and often impedes sleep for sufferers. The dryness and itchiness of the skin causes the person to scratch, which worsens the itch, which worsens the scratching, and the vicious cycle continues (Cole, 2020). Other signs and symptoms of atopic dermatitis include dry, red, inflamed, scaly, discolored skin.
There are no specific diagnostic tests for AD. Diagnosis of the disorder is based on specific criteria that consider the patient’s history and clinical manifestations (Kim, 2020).
The goal of treatment options is restoration of the protective skin barrier, which includes hydration and restoration of the skin, limiting itching, and decreasing inflammation (Kapur et al, 2018). Successful management entails education, good skin care and hygiene practices, anti-inflammatory treatments with topical corticosteroids (first-line) and/or topical calcineurin inhibitors (TCIs), and the treatment of skin infections, if warranted (Kim, 2020).
Atopic dermatitis and asthma are diseases that are both associated with inflammatory responses in the body. Studies suggest that there is a strong likelihood between having eczema as a child and developing asthma as an adult (Cherney, 2020). I am not sure how true it is, but my doctor has told me that there is a well-known correlation in patients with the triad of asthma, allergic rhinitis, and eczema and high IQ levels.
Scholarly APA responses atleast 2 , 8-10 lines