Typically impetigo appears in two classic forms, the usual crusted lesions and the less common bullous form. In the past one could assume that the former was secondary to Group A, beta-hemolytic streptococcus and the latter to Staphylococcus aureus. This clean separation cannot be used today as most impetigo in either form is due to Staphylococcus aureus. Crusted lesions appear as in Figure 1 with a golden yellow crust and little surrounding erythema. The history usually indicates the lesion beginning with an insect bite or minor superficial trauma followed by itching and crusting.
Regional lymphadenopathy is common.
Lesions spread rapidly if itching is not controlled and the wounds kept clean. Often several family members are affected. If several lesions are involved over disparate areas of the body systemic therapy with an anti-staphylococcal agent should be initiated. Parents should be encouraged to keep the child's fingernails short and buffed smooth. Anti-pruritic agents may be of some benefit in decreasing itching.