Treatment of Impetigo in the Pediatric Population:  Consensus and Future Directions

Schachner, Lawrence A.; Torrelo, Antonio; Grada, Ayman; Micali, Giuseppe; Kwong, Pearl; Scott, Gwenolyn B; Benjamin, Latanya; González, Mercedes E.; Andriessen, Anneke; Eberlein, Thomas; Eichenfield, Lawrence F.

doi:10.36849/jdd.2020.4679

Cited by 6 publications

(53 citation statements)

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“…8,9 Bacterial resistance is reported to many antibiotics prescribed for the treatment of impetigo, including mupirocin, retapamulin, and fusidic acid. [10][11][12][13][14][15] Another more recent therapeutic option is Ozenoxacin cream 1%, which has been developed for the first-line treatment of impetigo in patients from two months and up in the U.S. and Canada and six months in E.U. countries.…”

Section: The Algorithmmentioning

confidence: 99%

“…This bactericidal topical non-fluorinated quinolone has been studied in seventeen clinical trials to date but has not yet been incorporated in published practice guidelines for impetigo treatment. 10 Ozenoxacin has been shown to be highly effective against S. pyogenes and S. aureus, including methicillin-susceptible and resistant strains (MRSA). 42,43 Additionally, preliminary data show ozenoxacin's capacity to eradicate biofilm-forming MRSA at therapeutic concentrations.…”

Section: The Algorithmmentioning

confidence: 99%

“…Although there are guidelines on the skin and soft tissue infection treatment, currently, an algorithm that specifically addresses the treatment of impetigo is lacking. 5,10 An evidencebased impetigo treatment algorithm was developed to fill this gap.…”

Section: The Algorithmmentioning

confidence: 99%

“…There is an ongoing discussion regarding the definition of localized impetigo, which varies from five to ten lesions and an affected area smaller than 50 cm 2 up to 100 cm 2 . 10 Clinical trials of ozenoxacin, retapamulin, and mupirocin defined guidelines. Well-designed algorithms have inputs and outputs, are precise, and have uniquely defined steps.…”

Section: Preliminary Considerationsmentioning

confidence: 99%

“…Apart from the clinical presentation, underlying conditions such as a compromised immune status should be considered when defining treatment. 10,19,46,47 Differential Diagnosis For nonbullous impetigo, the differential diagnosis includes contact dermatitis, eczema herpeticum, herpes simplex, scabies, pemphigus foliaceous, and tinea infection. The presence of the characteristic golden crust should raise suspicion for impetigo.…”

Section: Diagnosis and Classificationmentioning

confidence: 99%

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Do Antimicrobial Resistance Patterns Matter? An Algorithm for the Treatment of Patients With Impetigo

Schachner¹,

Andriessen²,

Benjamin³

et al. 2021

JDD

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Background: Impetigo is a highly contagious bacterial skin infection commonly occurring in young children, but adults may also be affected. The superficial skin infection is mainly caused by Staphylococcus aureus (S. aureus) and less frequently by Streptococcus pyogenes (S. pyogenes). Antimicrobial resistance has become a worldwide concern and needs to be addressed when selecting treatment for impetigo patients. An evidence-based impetigo treatment algorithm was developed to address the treatment of impetigo for pediatric and adult populations. Methods: An international panel of pediatric dermatologists, dermatologists, pediatricians, and pediatric infectious disease specialists employed a modified Delphi technique to develop the impetigo treatment algorithm. Treatment recommendations were evidencebased, taking into account antimicrobial stewardship and the increasing resistance to oral and topical antibiotics. Results: The algorithm includes education and prevention of impetigo, diagnosis and classification, treatment measures, and follow-up and distinguishes between localized and widespread or epidemic outbreaks of impetigo. The panel adopted the definition of localized impetigo of fewer than ten lesions and smaller than 36 cm 2 area affected in patients of two months and up with no compromised immune status. Resistance to oral and topical antibiotics prescribed for the treatment of impetigo such as mupirocin, retapamulin, fusidic acid, have been widely reported. Conclusions: When prescribing antibiotics, it is essential to know the local trends in antibiotic resistance. Ozenoxacin cream 1% is highly effective against S. pyogenes and S. aureus, including methycyllin-susceptible and resistant strains (MRSA), and may be a suitable option for localized impetigo.

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Section: The Algorithmmentioning

confidence: 99%

Section: The Algorithmmentioning

confidence: 99%

Section: The Algorithmmentioning

confidence: 99%

Section: Preliminary Considerationsmentioning

confidence: 99%

Section: Diagnosis and Classificationmentioning

confidence: 99%

See 3 more Smart Citations

Do Antimicrobial Resistance Patterns Matter? An Algorithm for the Treatment of Patients With Impetigo

Schachner¹,

Andriessen²,

Benjamin³

et al. 2021

JDD

Self Cite

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Vulvar Erosions in a Child: A Case of Vulvar Impetigo

Rodríguez Sánchez,

Martín-Nieto González,

García Piqueras

et al. 2023

Pediatric Infectious Disease Journal

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Insights into acne and the skin barrier: Optimizing treatment regimens with ceramide‐containing skincare

Schachner,

Alexis,

Andriessen

et al. 2023

J of Cosmetic Dermatology

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IntroductionAcne is a common, complex, multifactorial inflammatory skin disease associated with epidermal barrier dysfunction. Beginning in childhood, acne affects many adolescents and adults. Acne is associated with lower self‐esteem, anxiety, and depression and may cause scars and pigmentary sequelae. The review explores the relationships between acne and the skin barrier function and discusses nuances in the prevention, treatment, and maintenance of acne and its impact on the skin barrier.MethodsThe advisors' previous publications addressed prescription and nonprescription pediatric acne treatment and skincare using cleansers, moisturizers, and a practical algorithm for treatment and maintenance, including skincare recommendations for pediatric acne patients and an algorithm for skin of color patients with acne.Before the meeting, literature was culled on the relationship between the skin barrier and acne and current best practices in acne, addressing prescription and nonprescription acne products and skincare as monotherapy, adjunctive, and maintenance treatment.ResultsAfter discussing 13 draft statements, the advisors applied the selected literature and drew from their clinical knowledge and experience, and agreed on five statements. The follicular epithelial barrier is directly involved with changes that occur during both comedogenesis and in stages of inflammation, especially with follicular rupture compromising the barrier's integrity. In acne‐affected skin, sebaceous glands are larger, sebum excretion and filaggrin expression higher, and stratum corneum lipids are reduced.Educating patients and clinicians about inflammation's central role in acne and measures to reduce inflammation is essential. Skin irritation and xerosis from acne and treatments lead to poor treatment adherence. A skincare regimen should be included in the acne prevention, treatment, and maintenance care regimen and should be ongoing. Maintenance treatment with topical agents and skincare using gentle ceramide‐containing cleansers and moisturizers is a recommended strategy after successfully controlling the disease.ConclusionsEpidermal barrier dysfunction contributes to acne exacerbation. Using the appropriate treatment and skincare helps to minimize irritation and inflammation, enhance treatment adherence, and improve patient outcomes.

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Treatment of Impetigo in the Pediatric Population: Consensus and Future Directions

Cited by 6 publications

References 0 publications

Do Antimicrobial Resistance Patterns Matter? An Algorithm for the Treatment of Patients With Impetigo

Do Antimicrobial Resistance Patterns Matter? An Algorithm for the Treatment of Patients With Impetigo

Vulvar Erosions in a Child: A Case of Vulvar Impetigo

Insights into acne and the skin barrier: Optimizing treatment regimens with ceramide‐containing skincare

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