What you need to know about impetigo

Impetigo is a highly infectious skin disorder with the greatest risk of affecting children aged 2 to 5 years. One symbol is a dark, itchy skin patch.

It is the most common bacterial skin infection in children in northern Europe, North America, and Canada but it can occur at any age. Where people live in cramped conditions, such as army barracks, or in dry, humid climates is more common.

Impetigo is rarely severe, and typically recovers within 2 weeks on its own. Often complications occur though, so a doctor can prescribe an antibiotic ointment or oral antibiotics.

Important facts about impetigo

  • Impetigo is a contagious skin infection that is most common in children.
  • It is caused by Staphylococcus aureus or Streptococcus pyogenes bacteria
  • Symptoms normally go away without treatment, but this depends on the type of impetigo and the severity of symptoms

Treatment

Impetigo infection symptoms
Impetigo can be successfully treated, but without treatment, it can become infected, and complications may result.
Image credit: Åsa Thörn 2011

Impetigo treatment helps to promote the recovery, enhance the appearance of the skin and avoid infections and infection spread.

Type of treatment may depend on type of impetigo and symptom severity.

If the infection is mild a doctor may recommend that the skin be kept clean.

A more serious infection will require antibiotic care.

Topical antibiotics

The topical antibiotics are directly applied to the skin. The doctor can prescribe an ointment with mupirocin, such as Bactroban. Scabs need to be gently removed before applying ointment, so that the antibiotic can get deep into the skin.

Before applying a topical antibiotic it is necessary to wash infected areas of the skin with warm soapy water. When applying the cream, latex gloves should be used where possible. Hands should be thoroughly washed after.

The patient will response to treatment within 7 days.

Oral antibiotics

These are prescribed when the impetigo is more severe or when the patient has failed to respond to topical antibiotics. The antibiotic type depends on the severity of infection, as well as other factors, including the medical condition of the patient and whether they have any allergies.

An antibiotic course normally takes about 7 days to complete. Completion of the course is necessary, even if symptoms clear up early.

A child can return to school 24 hours after the start of antibiotic treatment, or when the sores have healed and crusted.

Natural remedies

Tea tree oil, olive oil, garlic, coconut oil, and manuka honey have been reported to relieve impetigo symptoms, but further research is needed to confirm that.

Symptoms

The main symptoms of impetigo are red sores that burst and ooze before drying up.

The symptoms will depend on the type of impetigo.

Types

There are two main types of impetigo: Non-bullous and bullous.

Non-bullous impetigo, or impetigo contagiosa

Around 70 percent of cases of impetigo are of this type.

Small red blisters show up around the mouth and nose, or even in the extremities. Soon the blisters burst and ooze either fluid or blood, leaving thick, yellowish-brown golden crusts behind.

They leave a red mark as the crusts dry which normally heals without scarring.

They can be very itchy but the sores are not painful. To avoid the infection from spreading to other parts of the body and other people, it’s important not to touch or scratch them.

In some cases, signs of a fever and swollen glands can be more severe.

Bullous impetigo

Bullous impetigo is caused by some strain of Staphylococcus aureus which secretes a type of toxin that targets the layer of the skin. It affects mostly infants under the age of 2.

The toxin attacks a protein which helps keep the skin bonded. Once this protein is damaged, the bacteria may quickly spread.

Medium to large fluid-filled blisters on trunk, hands, and arms appear. The skin is red and itchy around the blister but not painful. Sometimes they spread rapidly, and finally burst, leaving a yellow crust. Normally the crust heals without scarring.

The blisters aren’t painful but can be itchy. Patients will strive to stop hitting or scratching them.

This type of imppetigo is common to fever and swollen glands.

Causes

Impetigo is caused by either:

  • Staphylococcus aureus (S. aureus)
  • Streptococcus pyogenes (S. pyogenes)

S. aureus is harmlessly present on human skin, and S. Pyogenes occur in flora of the regular mouth. They can however cause infection when a cut or wound occurs.

Infection can start in two ways:

  • Primary impetigo: Bacteria invade the normal, healthy skin without a site of entry.
  • Secondary impetigo: Bacteria invade the skin because another skin infection or condition has disrupted the skin barrier, such as eczema or scabies.

How do the bacteria enter the skin?

In adults, impétigo typically results from skin damage, often from another skin disease, such as dermatitis, a skin inflammation.

Children are usually infected following a cut, scrape, or bite of insects, but infection may occur without obvious damage to the skin.

How does it spread?

One person may become infected by touching items that have been in contact with an infected person, such as bed sheets, towels, toys and clothes. Once infected, that individual can easily pass it on to others.

Symptoms will not turn up until 4 to 10 days after initial bacterial exposure. People sometimes pass the infection on to others during those days, since they don’t know they’re infected.

Children may have a greater chance of becoming infected and showing symptoms because their immune systems are not yet fully developed.

The patient should remain at home when symptoms arise and not return to school or work until the lesions are dry with scabs or until 48 hours after starting antibiotic treatment.

Infants

Impetigo is popular in both preschool and school-age children. It can have an effect on the face, back, hands and diaper region.

Skin damage due to cuts, grazes, or poisonous ivy rash can cause the infection to come in.

It can spread easily between children. To that the risk, encourage children to regularly wash their hands, and not scratch or touch any wound or skin lesion. Keep separate washcloths, blankets, clothes and bedding, too.

Kids with any symptoms of impétigo should see a doctor. If sores after 3 days of care are not healed, or if a fever occurs, you should return to your doctor.

Diagnosis

Impétigo can be diagnosed relatively quickly by analyzing the region affected. The doctor is likely to ask the patient, parent, or caregiver about any recent wounds, scrapes, or bites of insects in the area affected.

They’ll even try to figure out whether it happened with any skin disease, like scabies.

Further tests may be ordered if:

  • symptoms are severe and have spread to many parts of the body
  • the patient does not respond to treatment
  • the infection keeps recurring

The doctor will clean a crusted area gently with a swab to see which bacteria triggers the impétigo and which antibiotics are most likely to work. A swab can also aid in deciding if another infection, such as ringworm or shingles, is present.

If the patient has frequent impetigo episodes, the doctor can take a swab from the nose to determine whether the infectious bacteria are present there.

Complications

Complications will happens very rarely. These may be dangerous. If the symptoms get worse the patient will come back to the doctor.

The following complications are possible:

  • Cellulitis: If the S. Aureus bacteria multiply and spread into deeper layers of skin, this is no longer impetigo, but a more serious complication, cellulitis. The skin will be red and inflamed, and there will be fever and pain.
  • Guttate psoriasis: Red, scaly patches of inflamed skin develop on all parts of the body. It is non-infectious and may occur in children and teenagers after a bacterial infection, especially a throat infection.
  • Scarlet fever: This is a rare bacterial infection caused by Streptococcus pyogenes. Symptoms include a fine, pink rash across the body, and possibly nausea, vomiting, and pain.
  • Bacteremia or sepsis: A bacterial infection of the blood, leading to fever, possibly rapid breathing, vomiting, confusion, and dizziness. This is a life-threatening infection and requires immediate hospitalization.
  • Post-streptococcal glomerulonephritis: An infection of the small blood vessels in the kidneys that can be fatal for adults. This complication of impetigo is very rare. Symptoms include darkened colored urine and hypertension. Hospitalization is usually necessary, to monitor blood pressure.

Prevention

Good hygiene is the best way to reduce the risk that impetigo can grow or spread. Immediately washing any cuttings, scrapes, grazes, and insect bites and keeping them clean can help to reduce the risk.

If someone has impetigo, keeping their belongings separated from others and strict hygiene measures are necessary.

The following will help prevent infection from spreading to others, and to other areas of the patient’s body:

  • washing the affected areas with a neutral soap and running water, then covering the area lightly with gauze
  • not touching the sores and discouraging the patient from doing so
  • keeping the patient’s clothes, bedding, towels, and other toiletries separate, and washing them daily at 60° Celsius (140° Fahrenheit) or higher
  • when applying antibiotic ointment, using gloves and washing hands thoroughly afterward
  • keeping the patient’s nails short to reduce scratching
  • ensuring both the caregiver’s and the patient’s hands are washed often
  • isolating the patient until they are not contagious

Assure that any skin disorder, such as eczema, is treated correctly to avoid a recurrence.To prevent a recurrence, make sure any skin condition, such as eczema, is treated properly.

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