Treatment of choice for severe impetigo?
**Core Concept:** Severe impetigo is a bacterial skin infection typically caused by Streptococcus pyogenes and Staphylococcus aureus. It is characterized by the development of multiple bullae, crusts, and generalized pruritus.
**Why the Correct Answer is Right:** The correct answer, **Diclofenac**, is a nonsteroidal anti-inflammatory drug (NSAID) that belongs to the phenylalkanoic acid class. It works by inhibiting the cyclooxygenase (COX) enzymes - COX-1 and COX-2 - which are responsible for the synthesis of prostaglandins. Inflammatory conditions like severe impetigo are primarily caused by increased prostaglandin synthesis, leading to inflammation, pain, and fever. By inhibiting COX enzymes, diclofenac reduces prostaglandin synthesis, thus providing symptomatic relief from pain, inflammation, and fever.
**Why Each Wrong Option is Incorrect:**
A. **Ibuprofen:** This is another NSAID, similar to diclofenac. However, it has a higher affinity for COX-1, leading to more significant inhibition of COX-1 than COX-2. This results in increased gastric side effects like ulcers and bleeding.
B. **Amoxicillin:** This is an antibiotic that targets bacterial infections, not the inflammation caused by severe impetigo. The correct treatment for severe impetigo involves both antimicrobial therapy and symptomatic relief.
C. **Hydrocortisone:** Hydrocortisone is a corticosteroid, which is an anti-inflammatory agent. Unlike NSAIDs, corticosteroids suppress both COX enzymes, leading to more significant systemic side effects.
**Clinical Pearl:** In severe impetigo, treatment should involve a combination of antibiotics (like amoxicillin) and nonsteroidal anti-inflammatory drugs (like diclofenac) for relief from pain and inflammation. The choice of NSAID depends on the patient's risk factors for gastrointestinal complications (e.g., age, concomitant use of aspirin, or history of peptic ulcers) while antibiotics should be chosen based on the causative organism (Staphylococcus aureus or Streptococcus pyogenes) and susceptibility patterns.