(Impetigol Impetigo sparsa)
Definition. An acute, inflammatory disease of the skin, characterized by the appearance successively or in crops of a few discrete superficial pustules.
Symptoms. While many observes doubt the existence of this form apart from impetigo contagiosa, it is certainly comparatively common and wholly unlike the contagious form. The onset of the eruption may be preceded by mild fever, malaise, and loss of appetite. The eruption consists of small, discrete vesicopustules which so rapidly change into larger pustules that the primary vesicular character is not observed. When formed, they vary in size from a split pea to a small cherry, yellowish white or darker in color, globular in form, fully distended, and appear to rest directly on the surface with little or no hyperemic areola. They may dry up without rupture, and form honey-like or brownish crusts attached to a slightly moist base, but pigmentation and scarring never ensues. The duration varies with the number weeks. The eruption is ordinarily located on the face, hands or fingers and less often on the lower extremities and feet. The lesions show no tendency to coalesce, rarely becomes grouped and are never abundant, seldom exceeding twenty individual lesions, often only one to five appearing. There may be slight sensations of tension or itching, which will cause the patient to pick rather than to scratch the affected parts.
Etiology and Pathology. This disease is practically a condition of childhood although occasionally seen upon the hands and fingers of adults. It is more common among the poor, underfed and unclean, although it may occur in any. Probably the instinctive habit in children of touching anything with their hand sand then touching their face with the latter, with their proverbial disregard of cleanliness, accounts for its more frequent occurrence in young children than in infants or adults. The efficient cause is a streptococcus or staphylococcus, singly or mixed. Through some slight abrasion, these microorganisms find entrance into the skin and set up an inflammation in the papillary layer of the corium forming small superficial abscesses covered by the epidermis.
Diagnosis. The lesions of impetigo simplex are pustular form the early beginning to the end, comparatively few in number, large in size non-elevated, often isolated, and tend to terminate in firm, thick crusts, without any marked subjective or constitutional symptoms during their entire course.
Impetigo contagiosa is contagious begins with vesicles, vesicopapules or vesicopustules, which frequently coalesce with or without rupture and dry into friable, wafer-like crusts. Ecthyma presents large flat pustules, seated on an inflammatory, hard and wider base, surrounded by a well-marked areolae. Moreover, ecthyma is associated with anemic or cachectic adults, and is seldom a disease of childhood. Pustular eczema presents pin-head and smaller sized pustules, aggregated in patches, often associated with other lesions, and attended with infiltration of the skin and positive itching. It is well to remember, however, that impetigo-like pustules may occur in the course of other pustular diseases of the skin.
Prognosis and Treatment. Spontaneous recovery may be expected in from five to ten days. No local treatment is needed beyond cleanliness and the application of a mild germicidal lotion or ointment. For suggestions as to internal remedies see those mentioned under Impetigo contagiosa.