Lesson 1Management of complications: cellulitis, post-streptococcal glomerulonephritis risk, and criteria for urgent referralAddresses recognition and management of impetigo complications, including cellulitis, invasive infection, and poststreptococcal glomerulonephritis, with emphasis on early warning signs and criteria for urgent specialist referral.
Recognizing and grading cellulitis severitySigns of systemic toxicity and sepsis riskPoststreptococcal glomerulonephritis overviewMonitoring urine, blood pressure, and edemaUrgent referral and hospitalization triggersLesson 2Differential diagnoses: herpes simplex, varicella, allergic contact dermatitis, bullous impetigo vs bullous impetigo-mimics — justification for eachDifferentiates impetigo from other pediatric vesiculobullous and crusted eruptions, including herpes simplex, varicella, and allergic contact dermatitis, with key clinical clues and justification for each alternative diagnosis.
Distinguishing impetigo from herpes simplexFeatures separating impetigo and varicellaAllergic contact dermatitis mimicking impetigoBullous impetigo versus staphylococcal scalded skinWhen to suspect autoimmune blistering diseaseLesson 3Microbiology and pathogenesis: Staphylococcus aureus and Streptococcus pyogenes roles, toxin-mediated bullaeExplores the microbiology and pathogenesis of impetigo, focusing on Staphylococcus aureus, Streptococcus pyogenes, toxin-mediated blistering, and host factors that influence colonization, invasion, and clinical severity.
Staphylococcus aureus virulence mechanismsStreptococcus pyogenes skin infection pathwaysToxin-mediated bullae and epidermal splittingRole of nasal and skin colonization sitesHost immunity and barrier function factorsLesson 4Examination details: honey-colored crusts, bullae, regional lymphadenopathy, mucosal involvementDetails focused skin and mucosal examination in suspected impetigo and vesiculobullous disease, highlighting lesion morphology, distribution, systemic signs, and lymph node findings to guide diagnosis, severity grading, and next steps.
Lesion morphology and evolution over timeDistribution patterns and body site predilectionAssessment of honey-colored crusts and erosionsEvaluation of mucosal and periorificial involvementPalpation of regional lymph nodes and edemaLesson 5Typical presentations: non-bullous and bullous impetigo, perioral/perinasal distribution, spreading patternsDescribes classic clinical patterns of nonbullous and bullous impetigo in children, including typical anatomic sites, spread along traumatized skin, and distinguishing features from other vesiculobullous pediatric eruptions.
Nonbullous impetigo facial and extremity lesionsBullous impetigo in infants and young childrenPerioral and perinasal distribution characteristicsPatterns of autoinoculation and lesion spreadRecognizing atypical or extensive presentationsLesson 6When to consider dermatology or infectious disease referral and indications for hospitalizationClarifies when primary care management is insufficient, outlining red flags that require dermatology or infectious disease input, criteria for hospital admission, and coordination of multidisciplinary care in complex or unstable children.
Red flag clinical features requiring escalationCriteria for dermatology subspecialty referralWhen to involve infectious disease specialistsIndications for emergency department assessmentHospital admission criteria and monitoring needsLesson 7Indications for diagnostic testing: wound swab and culture, PCR for HSV, when blood tests are warrantedExplains when diagnostic testing is indicated in pediatric impetigo and vesiculobullous eruptions, including swab culture, MRSA screening, HSV PCR, and blood tests, to refine therapy and evaluate systemic involvement.
When to obtain bacterial swab and cultureInterpreting culture and sensitivity resultsIndications for MRSA screening proceduresRole of HSV PCR in vesiculobullous lesionsWhen to order CBC, CRP, and renal testsLesson 8Infection control and public health: exclusion policies for school, hygiene, decolonization strategies, cleaning fomitesCovers infection control principles for impetigo and related infections, including school exclusion rules, hygiene education, decolonization strategies, and environmental cleaning to reduce transmission in households and community settings.
School and daycare exclusion and return rulesHand hygiene and nail care for childrenHousehold contact management and screeningTopical and systemic decolonization strategiesCleaning linens, toys, and shared fomitesLesson 9Counseling families on contagion, wound care, and return-to-school guidanceProvides strategies for counseling caregivers about contagion, wound care, medication use, and safe timing for return to school or daycare, emphasizing practical instructions that support healing and reduce household spread.
Explaining contagion and transmission routesHome wound cleansing and dressing techniquesUse of topical agents and avoiding home remediesBathing, clothing, and linen recommendationsReturn-to-school timing and documentationLesson 10Topical and systemic treatment regimens: mupirocin/fusidic acid topical regimens, oral antibiotics (cephalexin, amoxicillin-clavulanate, considerations for MRSA) with dose, frequency, durationReviews evidence-based topical and systemic antibiotic regimens for pediatric impetigo, including drug selection, dosing, duration, MRSA considerations, and strategies to limit resistance while ensuring clinical cure and adherence.
Indications for topical versus oral therapyMupirocin and fusidic acid dosing and durationFirst-line oral beta-lactam antibiotic choicesAdjusting therapy for suspected MRSA infectionCounseling on adherence and adverse effectsLesson 11Key history: febrile prodrome, timeline, contact exposures, school/nursery implications and contagion riskOutlines key history elements in suspected impetigo and vesiculobullous disease, including symptom chronology, fever, exposures, school setting, and risk factors that influence diagnosis, contagion counseling, and public health decisions.
Onset, progression, and prior skin conditionsFever, malaise, and systemic symptom reviewHousehold, school, and sports contact historyRecent trauma, insect bites, or skin barrier breaksPast MRSA, eczema, or recurrent infection history
