Impetigo is a common and highly contagious type of bacterial skin infection. While it is most common in children, no age group is exempt, and it is particularly contagious within the family. There are two types of impetigo. First, impetigo contagiosa, which presents with honey-colored crusts (scabs) and superficial erosions, often found on the face but can present on any part of the body. The second, but less common, is bullous impetigo, which presents with solitary fragile blisters which rupture easily, leaving raw, weeping, denuded areas which spread peripherally. New blisters sprout in the surrounding area. Prompt antibiotic therapy is rapidly curative.
Bacterial infections involving hair follicles are extremely common, particularly in shaved areas such as the beard, scalp and legs, but can occur in any hairy area. They may present as folliculitis, superficial pustules, similar to a whitehead with a hair in the center.
Bacterial infections involving the hair follicle may also present as a furuncle, which is a green-black necrotic plug (core) that is tenaciously embedded, little pus is present. When the infection is deep in the follicle at the hair bulb level, the surrounding subcutaneous tissue is involved, and a boil may form. A boil will usually drain into one sinus opening, exuding pus. When a much larger area is involved with multiple draining openings, it is referred to as a carbuncle. If pus is localized, it should be drained surgically, and then appropriate antibiotic therapy instituted. Antibiotic therapy without surgical draining will often be ineffective.
Bacterial paronychial (around the nail cuticle) infections are common particularly in nail biters, nurses, and after a manicure. These are extremely painful and present with redness, swelling and accumulated pus under the cuticle or lateral nail fold of a finger. It is very important these be treated early with drainage and antibiotics. If neglected, a felon may develop (a deep bacterial infection in the tendon spaces of the hand) which can prove extremely destructive with significant morbidity and loss of function.
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