Darmstadt G L, Lane A T
Department of Dermatology, Stanford University School of Medicine, California, Palo Alto 94304.
Pediatr Dermatol. 1994 Dec;11(4):293-303. doi: 10.1111/j.1525-1470.1994.tb00092.x.
This article reviews in detail the pathogenesis, clinical characteristics and management of impetigo in children. Impetigo is the most common bacterial skin infection of children. Most cases of nonbullous impetigo and all cases of bullous impetigo are caused by Staphylococcus aureus. The remainder of cases of nonbullous impetigo are due to group A beta hemolytic streptococci (GABHS). GABHS colonize the skin directly by binding to sites on fibronectin that are exposed by trauma. In contrast, S. aureus colonizes the nasal epithelium first; from this reservoir, colonization of the skin occurs. Patients with recurrent impetigo should be evaluated for carriage of S. aureus. Superficial, localized impetigo may be treated successfully in more than 90% of cases with topical application of mupirocin ointment. Impetigo that is widespread or involves deeper tissues should be treated with a beta-lactamase-resistant oral antibiotic. The choice of antibiotics is affected by the local prevalence of resistance to erythromycin among strains of S. aureus, antibiotic cost and availability, and issues of compliance.
本文详细综述了儿童脓疱病的发病机制、临床特征及治疗方法。脓疱病是儿童最常见的细菌性皮肤感染。大多数非大疱性脓疱病病例和所有大疱性脓疱病病例均由金黄色葡萄球菌引起。其余非大疱性脓疱病病例则由A组β溶血性链球菌（GABHS）所致。GABHS通过与创伤暴露的纤连蛋白位点结合直接定植于皮肤。相比之下，金黄色葡萄球菌首先定植于鼻上皮；由此，皮肤发生定植。复发性脓疱病患者应评估是否携带金黄色葡萄球菌。超过90%的浅表局限性脓疱病病例局部外用莫匹罗星软膏可成功治愈。广泛或累及深部组织的脓疱病应使用对β-内酰胺酶耐药的口服抗生素治疗。抗生素的选择受金黄色葡萄球菌菌株对红霉素耐药的当地流行情况、抗生素成本及可获得性以及依从性问题的影响。
