SKIN INFECTION: IMPETIGO

PRACTICE PATTERN- Pattern 7B (Impaired Integumentary System Associated with Superficial Skin
Involvment

Impairments of Body Functions and Structures, Activity Limitations, or Participation Restrictions

 Edema
 Impaired sensation
 Impairments associated with abnormal fluid distribution
 Impaired skin
 Ischemia

PATHOPHYSIOLOGY: Intact skin is usually resistant to colonization or infection by S aureus or GABHS.

These bacteria can be introduced from the environment and only transiently colonize the cutaneous
surface. The teichoic acid adhesions for GABHS and S aureus require the epithelial cell receptor
component, fibronectin, for colonization. These fibronectin receptors are unavailable on intact skin;
however, skin disruption may reveal fibronectin receptors and allow for colonization or invasion in these
disrupted surfaces. Factors that can modify the usual skin flora and facilitate transient colonization by
GABHS and S aureus include high temperature or humidity, preexisting cutaneous disease, young age, or
recent antibiotic treatment.

Signs and Symptoms:

*Non Bullous Impetigo

 Coalescing lesions on the face or in breaks in the skin

 Small vesicles of pustules that rupture and become a honey colored crust with moist
erythematous base.

*Bullous Impetigo (less contagious)

 Affects the face, trunk, axilla, extremities and perianal region of neonates
 Initial lesions are fragile thin roofed, flaccid and transparent with a clear, yellow fluid that turns
cloudy and dark yellow.
 Once the bullae rupture, they leave behind a rim of scale around an erythematous moist base
but no crust, followed by a brown-lacquered or scalded-skin appearance, with a collarette of
scale or a peripheral tubelike rim.

*bullous impetigo may involve the buccal mucous membranes, and regional adenopathy rarely occurs.
Extensive lesions in infants may be associated with systemic symptoms such as fever, malaise,
generalized weakness, and diarrhea. Rarely, infants may present with signs of pneumonia, septic
arthritis, or osteomyelitis.

Medical Assessment
The diagnosis of impetigo is usually made on the basis of the history and physical examination. However,
bacterial culture and sensitivity can be used to confirm the diagnosis and are recommended in the
following scenarios:

 When MRSA is suspected

 In the presence of an impetigo outbreak
 In the presence of poststreptococcal glomerulonephritis (PSGN); in such cases, urinalysis is also
necessary

Medical and Surgical Management

 Local wound care

 Anti-Biotic therapy
 Gentle Cleansing
 Application of wet dressings to areas
 Systemic antibiotics
 Intravenous Fluid resuscitation
 Deterrence and Prevention
 Consultation and Long term monitoring

Physical Therapist Assessment and Point of Emphasis

 Thorough inspection of wound

 Assessment of wound
 Patients overall health
 Nutritional factors
 Body build and Composition

PROBLEM LIST PLAN OF CARE INTERVENTION

Rate of Wound healing
Risk of infection
The risk of recurrence of
Impetigo
Increase rate of wound healing
Decrease rate of infection
Avoidance of recurrence
Educate patient in factors of
increasing wound healing like
Nutritional factors and
Hydration status of Patient
Apply proper wound care like
change dressing of wound and
protecting the wound by using
appropriate dressing and by
cleaning discharges and by dis
infection the wound with the
use of modalities with anti-
bacterial properties such as UV
Educate Pt. in risk of acquiring
impetigo whenever an exposed
wound comes in contact with a
wound or an object positive
with Staphylococcus Aureus