Bullous impetigo is a form of impetigo seen primarily in young children in which the vesicles enlarge to form flaccid bullae with clear yellow fluid, which later becomes darker and more turbid; ruptured bullae leave a thin brown crust.
Bullous impetigo is considered to be less contagious than the non-bullous form and unlike nonbullous impetigo, may involve the buccal mucous membranes, regional adenopathy rarely occurs and systemic symptoms are common, especially in younger age groups.
Usually there are fewer lesions than in non-bullous impetigo. It tends to affect the face, extremities, axillae and trunk. In neonates, the perianal region is also a common site for lesions.
Bullous impetigo is mostly by strains of S. aureus. Bullous impetigo is a toxin-mediated erythroderma in which the epidermal layer of the skin sloughs, resulting in large areas of skin loss.
Staphylococcal scalded skin syndrome differs from bullous impetigo. Both are blistering skin diseases caused by staphylococcal exfoliative toxin. However, in bullous impetigo, the exfoliative toxins are restricted to the area of infection, and bacteria can be cultured from the blister contents. In staphylococcal scalded skin syndrome, the exfoliative toxins are spread hematogenously from a localized source potentially causing epidermal damage at distant sites. Therefore, cultures of the bullous material are sterile.
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