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close this bookClinical Guidelines and Treatment Manual (Médecins Sans Frontières, 1993)
close this folderChapter 4 - Skin conditions
View the document(introductory text...)
View the documentDermatology
View the documentImpetigo and other purulent dermatoses
View the documentHerpes simplex, Herpes zoster
View the documentScabies
View the documentLeg ulcer
View the documentFungal infection
View the documentAnthrax
View the documentOther skin conditions
View the documentEndemic syphilis, Yaws & Pinta
View the documentLeprosy

Impetigo and other purulent dermatoses

Highly contagious skin infection (streptococcal or staphylococcal affecting mainly children of school age).

Clinical features

-Initially lesions located around orifices.

- Multiple crusty lesions, sometimes associated with pustules (one to several). Lesions are extended by scratching

- Acute impetigo produces bullous lesions.

- Streptococcal lesions are superficial, staphylococcal lesions are deep.

Treatment (dispensary)

- Cut fingernails, instruct mother to wash child daily with soap.

- Clean lesions with a disinfectant (chloramine or chlorhexidine-cetrimide solution; preparation: see table 25). Remove crusts, incise any abscesses.

- Apply gentian violet solution twice daily.

- On the scalp look for head lice or ringworm (tinea capitis).

- Explain treatment to the mother and treat other members of the family as necessary.

- Do not give antibiotics unless there are signs of regional or systemic spread. If so:
penicillin V(PO)
Adult: 2.4 MIU/d divided in 3 doses x 5 days
Child: 100,000 mg/kg/d divided in 3 doses x 5 days
If no improvement or extensive abscesses, staphylococcal infection is likely. If available give: erythromycin (PO): 50 mg/kg/d divided in 3 doses x 5 days
cloxacillin(PO): 100 mg/mg/d divided in 3 doses x 5-7 days

- Carbuncles on the face. There is a danger of intracerebral metastasis, so treat vigorously for 5-7 days.
If available:
cloxacillin (IV or PO): 100 mg/kg/d divided in 4 injections x 7 days
chloramphenicol(IV): 75 mg/kg/d divided in 4 injections x 7 days
ampicillin (IV): 100 mg/kg/d divided in 4 injections x 7 days
+gentamicin (IM): 3 mg/kg/d divided in 2 or 3 injections x 7 days