TOACS FCPS Station · Impetigo (Staphylococcal/Streptococcal Skin Infection)

📷 Clinical Photograph – Impetigo

Clinical photograph showing honey-crusted lesions of impetigo

Figure 1 · Impetigo · Honey‑Crusted Lesions

🔍 Key clinical features:

✓ Honey‑colored crusts – pathognomonic of impetigo
✓ Erythematous base with weeping lesions
✓ Bullous impetigo – flaccid bullae (S. aureus exfoliative toxin)
✓ Non‑bullous – thick golden crusts (S. aureus or GAS)
✓ Common on face, nose, mouth, and extremities

📋 Clinical scenario (examiner prompt)

A 4‑year‑old child presents with crusty sores on the face that started as small red bumps and progressed to honey‑colored crusts. The lesions are on the nose, cheeks, and around the mouth. There is mild erythema but no fever. The child attends daycare and has had similar lesions before. The clinical photograph is shown.

Honey‑crusted Face involvement Daycare contact No systemic symptoms

🧑‍⚕️ Examiner tasks · TOACS

1. Identify the diagnosis from the clinical image and history.

2. Describe the clinical features (honey‑crusted lesions, erythematous base).

3. Explain the etiology (S. aureus and/or Group A Streptococcus).

4. Discuss management (topical vs systemic antibiotics, hygiene).

⚠️ Key concept: Impetigo is a superficial skin infection caused by Staphylococcus aureus and/or Group A Streptococcus. The honey‑colored crusted lesions are characteristic. Bullous impetigo (S. aureus exfoliative toxins) presents with flaccid bullae. Treatment: topical mupirocin for limited lesions; oral antibiotics (cephalexin, dicloxacillin, clindamycin) for extensive or MRSA‑endemic areas.

🎯 Expected answers (for examiners)

• Diagnosis: Impetigo (non‑bullous)
• Clinical features: Honey‑colored crusts, erythematous base, face/perioral location, no systemic symptoms
• Etiology: S. aureus (most common), Group A Streptococcus, or mixed
• Management: Topical mupirocin (limited); oral cephalexin, dicloxacillin, or clindamycin (extensive/MRSA risk)

⚡ Quick FCPS‑style MCQ

A child with honey‑crusted lesions on the face and no systemic symptoms. The most appropriate initial treatment is:

A. Topical mupirocin B. Oral cephalexin C. Oral clindamycin D. IV vancomycin

Feature	Non‑Bullous	Bullous
Lesions	Honey‑colored crusts	Flaccid bullae → crusts
Pathogen	S. aureus or GAS	S. aureus (exfoliative toxins)
Location	Face, extremities	Trunk, extremities
Systemic	No	Rarely
Treatment	Topical or oral	Usually oral

🩻 TOACS FCPS Station · Impetigo

📷 Clinical Photograph – Impetigo

🧑‍⚕️ Examiner tasks · TOACS

📌 Topic summary ·