What is the typical disease course of with group A streptococcal (GAS) impetigo (impetigo contagiosa) (nonbullous impetigo)?

Updated: Sep 07, 2018
  • Author: Zartash Zafar Khan, MD, FACP; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Patients usually do not have systemic symptoms. Streptococcal impetigo begins with the appearance of a small papule that evolves into a vesicle surrounded by erythema. The vesicle turns into a pustule and then breaks down over 4-6 days to form a thick, confluent, honey-colored crust. The characteristics of streptococcal impetigo lesions thus contrast with the classic bullous appearance of lesions that arise from impetigo due to phage group II Staphylococcus aureus.

However, evidence now indicates that many cases of nonbullous impetigo are, in fact, mixed infections containing both S aureus and S pyogenes. Therefore, conclusions about etiology based on the clinical appearance of impetigo should be drawn with caution.


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