Nonbullous Impetigo - Causes, Symptoms, and Treatments

Introduction:

A great deal of skin infections exhibits extreme infectious and cause a great of discomfort for the patients. However, most of them settle within a couple of weeks even without considerable medical attention. Nonbullous impetigo is one such infective disease that exhibits extensive manifestations.

What Is Nonbullous Impetigo?

Nonbullous impetigo is a specific class of impetigo that is widely reported across the globe. It is a skin condition that typically targets the peripheral (external) skin layers. It is extensively encountered in school-going children, hence it is routinely known by the name school sores. Hot, arid climates provide favorable conditions for the disease to progress and spread rapidly. Bacteria is the sole agent that are responsible for these itchy and awful sore-like infections. Bacteria gains access into the body through small wounds or scratches, which eventually give rise to specific skin conditions. It significantly impacts the physical appearance of a person creating concerns and anxiety.

What Is Impetigo?

• Impetigo is quite a familiar category of skin infection that is exceptionally transmissible.It is often associated with stinging, prickling, and soreness. A person can easily catch impetigo from another infected person through physical contact or touch.

• Younger individuals are the target population however, anybody can acquire the infection from an infected person.

• Two distinctive groups of impetigo are identified and reported; nonbullous impetigo and bullous impetigo. These groups differ specifically in their mechanism of causation and manifestations. However, both are bacterial infections involving the skin.

• Impetigo holds a significant position among skin infections, particularly affecting the younger population.

• At times, an already existing wound may get further infected with bacteria responsible for impetigo, which eventually gives rise to a condition termed as impetiginisation.

What Causes Nonbullous Impetigo?

• Nonbullous impetigo is purely a bacterial disease. Staphylococcus aureus is reported to be the prime bacterial agent that brings about nonbullous impetigo.

• Occasionally Streptococcus pyogenes (group A beta-hemolytic streptococcus) are also elicited in nonbullous impetigo patients.

• Rarely these two bacterial species together, hand in hand give rise to this skin condition. Certain resistant variants like gentamicin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus aureus.

• Skin shields the internal organs and our body from getting exposed to disease-causing microbes. Once any discontinuation or abrasion develops over the skin surface, those areas act as an entry point for disease-causing microorganisms like bacteria.

• These skin abrasions may happen either by accidental injury or due to other preexisting skin diseases. Through these entry points, the culprit bacterias gain access to the body and, later on, give rise to nonbullous impetigo.

• A healthy person can catch the disease very easily, upon direct contact with another affected person.

• Sometimes the disease spreads within the body of a person from one site to another, bringing about extensive involvement. Its infectious and spreading nature makes it a health concern, though it is not a grave disease.

What Are the Associated Signs and Symptoms of Nonbullous Impetigo?

Nonbullous impetigo is often encountered with extensive skin manifestations. Some of the routinely elicited symptoms include the following:

• Facial Involvement: Nonbullous impetigo preferentially develops over the exposed parts of the body like the face, hands, and legs. However, infrequently it is seen over other bodily areas as well.

• Skin Sores: In the initial phase, numerous tiny pimple-like (pustules) boils develop over the skin, eliciting redness over the area. Later on, these projections merge with each other acquiring a more extensive size which eventually breaks off and gives rise to a typical crusty appearance. This crust exhibits a characteristic yellow tint, thus simulating appearance like a cornflake's.

• Discharge: The breakage and opening up of the skin boils are often accompanied by some form of release, which is often thin and serous.

• Fever: Nonbullous impetigo is frequently encountered with a general rise in the body temperature that signifies the ongoing infection in the body.

• Lymphadenopathy: Just like other infectious conditions, nonbullous impetigo also elicits associated bulging of the lymphatic nodes present in the body.

• Itching: A strong scratchiness and itching sensation develops, especially in the involved skin areas. Scratching often contributes to the further spread and extension of the infection within the body as well as to others. Rarely nonbullous impetigo elicits soreness.

• Self-Inoculation: It is a peculiar feature of nonbullous impetigo in which the microbe extends to other areas of the body, even with intact skin, producing sores over there.

What Are the Risk Factors for the Development of Nonbullous Impetigo?

Certain factors and conditions elevate the likelihood of developing nonbullous impetigo. Some of the potential risk factors include the following:

• Weakened immunity.

• Compromised personal hygiene.

• Diabetes mellitus.

• Atopic dermatitis (skin irritation).

• Contact dermatitis (skin allergy).

• Chickenpox (viral infection).

• Undernutrition.

• Insect bites.

• Arid climate.

• Skin damages.

• Congested living setup.

How Is Nonbullous Impetigo Diagnosed?

An in-depth analysis of the clinical findings and medical history often leads to the diagnosis of nonbullous impetigo. In addition, certain diagnostic tests are often advised to figure out the presence of suspected bacteria and other resistant variants, if any. Routinely recommended investigatory tests include the following:

• Skin Swab: It is advised to collect the swab from the site of infection, particularly the crusted area, as it encompasses colonies of bacteria. The collected swab is then analyzed to detect the pathogenic microorganism.

• Nasal Swab: It helps to detect the presence of bacterial growth in the nasal area. Swab tests often aid the treatment strategy by figuring out the bacterial variant with notable resistance to the medicines.

• Biopsy: It provides a clear picture of the skin sore at its cellular level. It aids in ruling out other deadly skin conditions.

What Are the Treatment Interventions Available for Nonbullous Impetigo?

• Nonbullous impetigo is not an aggressive skin condition and does not routinely demand treatment. Most often, it settles by itself within a couple of weeks with proper care to check self-inoculation and spreading.

• If the condition tends to linger for longer than expected and, even reappears frequently, then it necessitates treatment.

• Antibiotic therapy is the routinely advised and globally accepted treatment strategy for nonbullous impetigo. Antibiotics are widely recommended in two specific forms - topical and oral.

• Mupirocin and Fusidic acid ointment are the regularly prescribed topical forms. In case of a restricted number of skin sores, antiseptic therapy using povidone-iodine and hydrogen peroxide is preferred, instead of antibiotic therapy.

• When there is widespread and extensive involvement, oral antibiotics like, Flucloxacillin and Erythromycin, are advised to tackle the progression of the infection.

• Resistant variants are often effectively treated with a combination of Sulfamethoxazole and Trimethoprim.

Conclusion:

Nonbullous impetigo is a common skin disease, producing sores that are known for their ability to spread. Proper hygiene and care can often help prevent the condition even without any medicines. But certain patients have recurrent and long-standing skin sores, that call for medical attention and treatment.