EpistemisMeliceric scabs
Specialty: Skin.
Why it occurs
- Primary non-bullous impetigo contagiosum (superficial bacterial infection caused mainly by *Staphylococcus aureus* or *Streptococcus pyogenes*)
- Secondary impetiginization of a previous dermatosis (scratching of atopic dermatitis lesions, scabies or insect bites)
- Ecthyma (deeper infection that penetrates to the dermis, leaving punched-out ulcers with thick scabs with a necrotic base)
- Superinfected seborrheic dermatitis (false meliceric scab on the scalp)
- Herpes simplex type 1 infection with secondary bacterial superinfection.
Initial workup
Eminently clinical diagnosis based on the classic morphological appearance. In cases of suspected bacterial resistance or institutional outbreaks, culture of the purulent exudate obtained after carefully lifting the scab, with its corresponding antibiogram. Evaluation of kidney function by urinalysis in case of suspected nephritic complication.
red flags
Appearance of multiple extensive flaccid blisters that break easily (severe bullous impetigo), concomitant high fever, lethargy or signs of systemic involvement, or appearance of coluric (dark) urine and facial edema 1-3 weeks after infection (suspected poststreptococcal glomerulonephritis).
Standard management
- Mupirocin 2% ointment — topical antibiotic that inhibits bacterial protein synthesis; applied 3 times a day for 5 to 7 days on localized lesions
- Retapamulin 1% ointment — effective topical alternative in localized superficial bacterial infections
- Cephalexin — oral beta-lactam antibiotic indicated in case of disseminated lesions or refractory to topical treatment, dose of 250 to 500 mg every 6 hours for 7 days
- Gentle removal of scabs by means of promotions with Alibour water or saline solution before applying the topical antibiotic.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 5
- Treatment options
- 4