Impetigo (°í¸§µüÁöÁõ, ³ó°¡Áø)

The Root of Ambulatory Care
- Àú ÀÚ : ÀÌÁø¿ì
- Ãâ ÆÇ : ±ºÀÚÃâÆÇ»ç
- ÆäÀÌÁö¼ö: 543¸é
ÀÌÁø¿ì ¼±»ý´Ô, ±ºÀÚÃâÆÇ»ç¿Í Á¦ÈÞ¸¦ ÅëÇØ Ã¥ ³»¿ë ¹× ±×¸²À» Á¦°øÇÕ´Ï´Ù.
¹«´Ü º¹Á¦/¹èÆ÷ ±ÝÁö.
KEYWORDS:
..Á¢ÃË¿¡ ÀÇÇØ Àü¿°µÇ´Â ÇǺÎÀÇ ¾èÀº Ç¥À缺 È³ó¼º °¨¿°
Bullous impetigo
¢º À©ÀÎ±Õ : Staphylococcus aureus, phage group 2
¢º ÁÖ·Î ¿©¸§Ã¶¿¡ »ýÈÄ 4~10ÀÏ »çÀÌÀÇ ½Å»ý¾Æ¿¡¼ ¹ß»ýÇϸç Àü¿°·ÂÀÌ ¸Å¿ì ³ô´Ù.
¢º È£¹ßºÎÀ§ : ¾ó±¼, ¼Õ
Impetigo contagiosa (>70%)
¢º À©ÀÎ±Õ : Staphylococcus aureus (ñ«), Streptococcus, Streptococcus+Staphylococcus
¢º ÁÖ·Î ¿©¸§Ã¶ ¼Ò¾Æ¿¡¼ ¹ß»ý
¢º È£¹ßºÎÀ§ : ¾ó±¼(ÄÚ, ÀÔ ÁÖÀ§), ÆÈ´Ù¸®
¢º °¨¿°°æ·Î : ¼Ò¾Æ-¼ÕÅé, ¾Ö¿Ïµ¿¹°, °¨¿°µÈ ´Ù¸¥ ¼Ò¾Æ /¼ºÀÎ-À̹߼Ò, »ç¿ì³ªÅÁ, ¼ö¿µÀå, °¨¿°µÈ
¼Ò¾Æ
Impetigo contagiosa by Streptococcus
..¸²ÇÁ¼± Á¾Ã¢ÀÌ »ý±æ ¼ö ÀÖ´Ù.
..±Þ¼º »ç±¸Ã¼ ½Å¿°ÀÌ ¹ß»ýÇÒ ¼ö ÀÖ´Ù.
- ¹ß»ýÀ² : 2~5%
- 6¼¼ÀÌÇÏÀÇ ¼Ò¾Æ¿¡¼ È£¹ß
- °¨¿° 18~21ÀÏ »çÀÌ¿¡ È£¹ß
- ´«ÁÖÀ§, ÇÏÁöÀÇ ºÎÁ¾
- Ç÷´¢, ´Ü¹é´¢
- Anti-DNase B, antihyaluronidaseÁõ°¡/ASOÁõ°¡´Â ¾øÀ½
- good prognosis(¼Ò¾Æ)/poor prognosis(¼ºÀÎ)
Impetigo
1. Itching
2. Crusting
3. Blisters
1. Red papules early : Impetigo contagiosa
2. Vesicles
3. Pustules
4. Bullae : Bullous impetigo
5. Honey-colored crusts : Impetigo contagiosa
6. Regional lymphadenopathy
7. Absence of constitutional Symptoms
439
The Root of ambulatory care
Key symptoms
Key signs
¢º Bullous impetigo
¢º Bullous impetigo
Key tests
Key treatments
Key treatments
Impetigo
- not routinely
1. Gram¡¯s stain
2 Culture & sensitivity
3. Antihyaluronidase & anti-DNase B for group A ¥âhemolytic streptococcal infections
(ASO production is inhibited by lipids in the skin)
4. Urine test if acute glomerulonephritis suspected
- Nonpharmacologic
1. Debridement of crust with wet soaks for 20minutes three times daily,
followed by gentle scrubbing with a washcloth.
2. Fingernails should be kept short and scratching discouraged to avoid spread
of infection.
3. Use of an antibacterial soap, as well as avoidance of towels and washcloths
used by the affected individual, is crucial to avoiding spread of infection.
4. Children should be removed from day care until 24hours after antibiotic
treatment is initiated.
- Pharmacologic
1. Topical antibiotics
.. Bactroban.. bid-tid for 10days or healingÈÄ 1ÁÖ°£ µµÆ÷
2. Systemic antibiotics
- diffuse impetigo
..Kefacin.. 500mg¨ö-1C qid
¼Ò¾Æ 25-50mg/kg/day every 6hours
..Augmentin.. 250/125mg 1T, 1-2T tid
¼Ò¾Æ Augmentin.. Duo syrup 0.625~1.125ml/kg # 2
..Zithromax.. 250mg 1T, 2T for first day and 1T for followed 4days
¼Ò¾Æ 10mg/kg for first day and 5mg/kg for followed 4days
..Eryc.. 250mg 1C tid -qid
¼Ò¾Æ 40mg/kg/day every 6hours : ³»¼º±ÕÀÌ ¸¹¾Æ È¿°ú ¶³¾îÁü
441
The Root of ambulatory care
..Bactrobanr.. - Mupirocin
..Eryc.. - Erythromycin
..Kefacin.. - Cephalexin
..Augmentin.. - Amoxicillin+Clavulanate
..Zithromax.. - Azithromycin
..°¡º¿î º´º¯¿¡¼± °æ±¸¿ë Ç×»ýÁ¦¸¦ º¹¿ëÇϴ°ͺ¸´Ü Topical therapy
(Mupirocin)°¡ ´õ È¿°úÀûÀ̶ó´Â º¸°í°¡ ÀÖ´Ù.
..Àü¿°¼º ³ó°¡Áø¿¡¼ °¡ÇǸ¦ Á¦°ÅÇÏ´Â °ÍÀº Ä¡·áÈ¿°ú¸¦ ³ôÀÏ ¼ö ÀÖÁö¸¸ ¼Ò¾Æ
¿¡¼´Â ÅëÁõ¶§¹®¿¡ ¾ÖµéÀÌ Ä¡·á¸¦ ±âÇÇÇÒ ¼ö ÀÖÀ¸¹Ç·Î ¹Ù¸£´Â ¾àÀ» ¿½ÉÈ÷
¹Ù¸£°í °æ±¸ Ç×»ýÁ¦¸¦ º¹¿ëÇÏ´Â °ÍÀÌ ÁÁ´Ù.
Âü°í ¹®Çå
Laeth S. Nasir : Impetigo, in Saunders Manual of Medical Practice, 2nd ed, Robert E. Rakel(ed).
Philadelphia, Saunders, 2000, P 1217-1218
¼Û»ó¿í : ¼¼±Õ¼º ÇǺΠÁúȯ, in °¡Á¤ÀÇÇÐ ÀÓ»óÆí. ¼¿ï, °èÃø¹®È»ç, 2002, P 1100-1107
Frederic W. Stearns,M.D. : Bacterial diseases of the Skin, in Conn's Current Therapy 2004, Robert E.
Rakel(ed), Edward T. Bope(ed_). Philadelphia, Saunders, 2004, P 862-864
¿Àâ¼®(ed) : ³ó°¡Áø, in Complete Guide To Practical Based Prescription Medicine. ¼¿ï, Çѿ츮, 2005,
P 276-277
±è³²¼ö : ¼¼±Õ°¨¿°, ¿È, °ïÃæÀÚ»ó, in Atlas of Skin disease. ¼¿ï, ÇѹÌÀÇÇÐ, 2002, P 337-354
¾È¼º±¸ ¿Ü (¿ª) : ¼Ò¾ÆÇǺÎÁúȯ. ¼¿ï, ±ºÀÚÃâÆÇ»ç, 2004, P 491