Children with nonbullous impetigo commonly have multiple coalescing lesions on their face (perioral, perinasal) and extremities or in areas with a break in the natural skin defense barrier. The initial lesions are small vesicles or pustules (< 2 cm) that rupture and become a honey-colored crust with a moist erythematous base. Pharyngitis is absent, but mild regional lymphadenopathy is commonly present. Nonbullous impetigo is usually a self-limited process that resolves within 2 weeks.
Bullous impetigo is considered to be less contagious than the nonbullous form.[6] It tends to affect the face, extremities, axillae, trunk, and perianal region of neonates, but older children and adults can also be infected.[4] The initial lesions are fragile thin-roofed, flaccid, and transparent bullae (< 3 cm) with a clear, yellow fluid that turns cloudy and dark yellow. Once the bullae rupture, they leave behind a rim of scale around an erythematous moist base but no crust, followed by a brown-lacquered or scalded-skin appearance, with a collarette of scale or a peripheral tubelike rim.
Bullous impetigo also differs from nonbullous impetigo in that bullous impetigo may involve the buccal mucous membranes, and regional adenopathy rarely occurs. However, extensive lesions in infants may be associated with systemic symptoms such as fever, malaise, generalized weakness, and diarrhea. Rarely, infants may present with signs of pneumonia, septic arthritis, or osteomyelitis.