Impetigo
Also called school sores
Superficial bacterial infection (S. aureus, S. pyogenes) of children: fragile vesicopustules that rupture into the signature honey-coloured crusts, typically around the nose and mouth. Highly contagious.
How it looks
Multiple erosions with honey-coloured crusts clustered around the nares and mouth of a child, with scattered satellite lesions.
Rose is the lesion, grey the pattern the lesions make, green where on the body it lives.
Across skin tones
The honey crust is a colour clue that survives all baseline pigmentation, it reads golden on any skin.
Forms & variants
Bullous impetigo
Flaccid, fluid-filled blisters from staphylococcal exfoliative toxin, favouring the trunk of infants; the localized cousin of staphylococcal scalded skin syndrome.
Impetiginized eczema
Atopic dermatitis wearing impetigo's honey crust: golden crusting and weeping spreading across an existing flexural rash. Treat the infection and the underlying eczema together, or it returns.
Symptoms & course
- Mild itch, minimal pain
- Spreads to contacts and to other body sites by scratching
Diagnostic approach
- Clinical; swab for culture when recurrent or outbreaks occur
Differential, and how to separate them
- Herpes zoster
Favours it: Painful grouped vesicles in a band, adults
Against it: Impetigo crusts golden and is peri-orificial in children
- Atopic dermatitis
Favours it: Chronic itchy flexural disease
Against it: But weeping golden crust on eczema IS impetiginisation, the two coexist
Management principles
- Topical antibiotic for limited disease; oral for extensive
- Hygiene measures, towels, nails, school exclusion per local policy
Clinical pearl: Honey-coloured crust is one of dermatology's few genuinely pathognomonic colours.
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