In staphylococcal disease, the typical lesion is a golden crust covering a shallow ulcer with an oozing base. The child is otherwise well and asymptomatic. The lesions of streptococcal impetigo are deeper ulcers with collections of pus in the early stages and later a firm, adherent crust. The child may be febrile and the lesions are often painful. Lesions may be superimposed on other skin disease such as insect bites, head lice, scabies or eczema.
Management Look for underlying disease.
If streptococcal, remember the possibility of post-streptococcal glomerulonephritis and follow up for several weeks checking urine for red cells and protein. This is caused by staphylococcal strains which produce epidermolytic toxin. Small blisters appear which enlarge quickly and rupture, producing large denuded ares which are glazed in appearance and dry quickly. The lesions are not itchy and rarely tender. The child is systemically well.