|Clinical Guidelines and Treatment Manual (Médecins Sans Frontières, 1993)|
|Chapter 4 - Skin conditions|
Highly contagious skin infection (streptococcal or staphylococcal affecting mainly children of school age).
-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.
- 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:
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.
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