Bullous Impetigo

Aka: Bullous Impetigo

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II. Epidemiology

  1. Represents 10-30% of Impetigo cases
  2. Affects infants (esp. newborns) and young children
  3. Less contagious than NonBullous Impetigo
  4. Most common cause of ulcerative buttock rash in infants

III. Pathophysiology

  1. Unlike NonBullous Impetigo, Bullous Impetigo is caused only by staphyococcus aureus
  2. Staphylococcal toxin-mediated reaction
  3. Staphylococcal Infection with Phage Group 2
    1. Local variant of Staphylococcal Scalded Skin Syndrome

IV. Symptoms: Systemic symptoms in less typical cases

  1. Fever
  2. Diarrhea
  3. Weakness

V. Signs

  1. Distribution
    1. Intertriginous areas (diaper, axilla, neck)
  2. Characteritics
    1. Onset with vessicles enlarging quickly to bullae
    2. Flaccid bullae, 1-2 cm diameter with sharp margins
      1. No surrounding erythema (unlike nonbullous form)
    3. Bullae break leaving characteristic appearance
      1. Thin yellow serous crust
      2. Small rim of Blister roof at edge of lesion
  3. Pathognomonic Signs (Collarette Sign)
    1. Collar of scale forms around ruptured Blister roof

VI. Differential Diagnosis

  1. Common
    1. Contact Dermatitis
    2. Herpes Simplex Virus
    3. Varicella
    4. Insect Bites
    5. Burn Injury (e.g. Cigarette burns)
  2. Uncommon
    1. Bullous variants of other conditions
      1. Erythema Multiforme
      2. Systemic Lupus Erythematosus
      3. Scabies
      4. Fixed Drug Eruption
    2. Stevens-Johnson Syndrome
    3. Bullous Pemphigoid
    4. Pemphigous vulgaris
    5. Dermatitis Herpetiformis

VII. Management

  1. See Impetigo

VIII. Course

  1. Self-limited, non-scarring
  2. Resolves within 2-3 weeks

IX. References

  1. Cole (2007) Am Fam Physician 75(6):859-68 [PubMed]
  2. Brown (2003) Int J Dermatol 42:251-5 [PubMed]

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Ontology: Bullous impetigo (C0021100)

Concepts Disease or Syndrome (T047)
ICD10 L01.03
SnomedCT 359754006, 200703007, 367404007, 12318008, 399183005
English Bullous impetigo, bullous impetigo, bullous impetigo (diagnosis), impetigo bullosa, impetigo bullous, Bullous impetigo (disorder), Impetigo bullosa, Impetigo contagiosa bullosa, Impetigo bullosa (disorder), bullous; impetigo, impetigo; bullosa, Bullous impetigo [Ambiguous], Impetigo bullosa (disorder) [Ambiguous], Impetigo contagiosa of any site and any organism, bullous, Impetigo contagiosa, bullous, Impetigo, bullous
Italian Impetigine bollosa
Dutch impetigo bullosa, bulleus; impetigo, impetigo; bulleus, bulleuze impetigo
German Impetigo bullosa, bulloese Impetigo
Portuguese Impetigo bulhoso, Impetigo bolhoso
Spanish Impétigo ampolloso, impétigo ampollar (trastorno), impétigo ampollar, impétigo ampollar contagioso, impétigo ampollar (concepto no activo), impétigo bulloso (trastorno), impétigo bulloso, Impétigo bulloso
Japanese 水疱性膿痂疹, ｽｲﾎｳｾｲﾉｳｶｼﾝ
Czech Bulózní impetigo
Hungarian Impetigo bullosa, bullosus impetigo
French Impétigo bulleux
Derived from the NIH UMLS (Unified Medical Language System)

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