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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