Impetigo

Impetigo is a skin infection that is usually caused by one of two types of bacteria: group A streptococcus or staphylococcus aureus. It is one of the most common skin infections among children, especially of preschool and school age, and is highly contagious. During the summer months, when the weather is warm and humid, bug bites, poison ivy exposure and other skin injuries abound. Children are typically more vulnerable than adults to the bacteria, which can lie harmless on the skin until they find a break to enter and spread. This is because children, who already have developing immune systems, may also have lower hygienic standards and often scratch a bug bite or irritation, giving impetigo an invitation to enter and infect the skin.


Impetigo manifests itself through blisters and sores on the hands and face, although it can infect any part of the body. The two types of bacteria that cause impetigo manifest themselves in different ways. The most common cause of impetigo, staphylococcus aureus, results in large blisters that start out clear, then turn cloudy. They don’t burst easily, and they tend to remain intact for a fairly long period of time.


The second type of bacteria, streptococcus, is characterized by a group of tiny blisters that burst. After they have burst, they leave small, wet areas of skin that can weep fluid. The fluid crusts over, leaving the affected area covered in what appears to be crystallized honey or brown sugar.


The three types of impetigo are called impetigo contagiosa, bullous impetigo and ecthyma. The first and most common, impetigo contagiosa, usually starts around the nose and mouth and is characterized by the small red sores seen with the streptococcus strain of bacteria. Those affected may also have swollen lymph nodes around the area of infection. With bullous impetigo, the infection is often caused by the staphylococcus aureus bacteria, causing large, painless blisters, usually on the trunk of the body or on the legs or arms. The blisters, which last longer than the impetigo contagiosa infection, can be accompanied by fever, diarrhea and body weakness.


Ecthyma is a more serious form of impetigo. The infection spreads deep into the dermis, or second layer of skin. It starts out with painful, fluid-filled blisters that progress to deep ulcers, primarily affecting the legs and feet. A yellow-gray crust thickly covers the infected area. Swollen lymph nodes can accompany this type of impetigo. Unfortunately, these deep blisters usually result in scarring.


Symptoms

The following are signs and symptoms of impetigo:



Types of impetigo

Impetigo contagiosa, also known as nonbullous impetigo. The most common form of impetigo is impetigo contagiosa, which usually starts as a red sore on your child's face, most often around the nose and mouth. The sore ruptures quickly, oozing either fluid or pus that forms a honey-colored crust. Eventually the crust disappears, leaving a red mark that heals without scarring. Impetigo sores may be itchy, but they aren't painful.


Your child isn't likely to have a fever with this type of impetigo but may have swollen lymph nodes in the affected area. And because it's highly contagious, just touching or scratching the sores can spread the infection to other parts of the body.


Bullous impetigo. This type primarily affects infants and children younger than 2 years. It causes painless, fluid-filled blisters — usually on the trunk, arms and legs. The skin around the blister is usually red and itchy but not sore. The blisters, which break and scab over with a yellow-colored crust, may be large or small, and may last longer than sores from other types of impetigo.


Ecthyma. This more serious form of impetigo penetrates deeper into the skin's second layer (dermis). Signs and symptoms include painful fluid- or pus-filled sores that turn into deep ulcers, usually on the legs and feet. The sores break open and scab over with a hard, thick, gray-yellow crust. Scars can remain after the sores heal. Ecthyma can also cause swollen lymph nodes in the affected area.


Treating impetigo

Impetigo is not usually serious and will often clear up without treatment after two to three weeks. However, if you or your child has symptoms, you should visit your GP to rule out the possibility of other, more serious infections.


If impetigo is confirmed, it can usually be effectively treated with antibiotics which may be prescribed in the form of a cream (topical) or as tablets. With treatment, the infection should clear up after about 7 to 10 days and the time that the person is infected will also be reduced.


Antibiotic cream

Before applying antibiotic cream, you should wash any affected areas of skin with warm, soapy water.


To reduce the risk of spreading the infection, it is also important that you wash your hands immediately after applying the cream or, if available, wear latex gloves while applying the cream.


Antibiotic tablets

Antibiotic tablets (oral antibiotics) may be prescribed if the infection is severe and spreads rapidly, or if your or your child’s symptoms do not improve after using antibiotic cream.


A seven-day course of oral antibiotics is usually recommended. If a course of oral antibiotics are prescribed for you or your child, it is very important that you (or they) finish the course even if the symptoms clear up.


Side effects of oral antibiotics can include:



If the blisters continue to produce fluid it is a sign that they are still infectious. Impetigo stops being infectious after 48 hours (two days) of treatment starting. Therefore, if your child has impetigo they should be able to return to school or nursery:



If symptoms have not improved within seven days of starting treatment, you should go back to your GP for a follow up appointment to discuss other treatment options.