Dr. Tariq Jagnarine FMed, Endocrinology/Diabetes
Impetigo is a very common skin infection that causes sores and blisters. It affects mainly children. It’s sometimes called ‘school sores. Impetigo is contagious and can be very dangerous for newborn babies. It’s important to keep children who have impetigo away from babies and they should not go to school or childcare until 24 hours after antibiotic treatment has started, or until the blisters have dried out.
CAUSES
Impetigo is caused by staphylococcus or streptococcus bacteria. The bacteria may penetrate the skin if it is scratched or broken due to conditions such as:
Atopic dermatitis (eczema)
Scabies
Insect bites
Head lice
Impetigo usually affects young children, because the infection spreads easily in places such as schools and childcare centers.
Impetigo in adults is more common when people are living in a confined area, such as army barracks, or if someone has a lowered immune system.
Speak to a doctor if you or your child has symptoms of impetigo. Impetigo is not usually serious, but it may be confusing with other skin conditions such as cellulitis, contact dermatitis and insect bites. Your doctor will be able to rule these out.
SYMPTOMS
Impetigo causes sores on the skin. These blisters can grow quickly and then burst, leaving a moist area with a brown crust at the edge. The blisters can be large (several centimetres across) and itchy. Sometimes, the stores have a thick, soft, yellow crust with a moist red area underneath.
Small blisters can join to form large, loose, floppy blisters. This is called bullous impetigo.
The sores appear 1 to 3 days after exposure to the infection. They are contagious if there is fluid weeping from them. They are no longer contagious when they have scabbed over or 24 hours after starting antibiotic treatment.
Other symptoms may include a fever, swollen lymph nodes (glands) or feeling generally unwell.
DIAGNOSIS
If someone thinks they or their child may have impetigo, see a doctor. They can diagnose it by examining your skin and looking at the sores. They may also take a swab to test for bacteria and identify the most effective treatment.
TREATMENT
Antibiotics are usually prescribed in the form of cream, ointment, tablets or syrup depending on the severity of the condition. Always complete the full course of treatment that your doctor prescribes. This will help prevent the infection from coming back and reduce the chance of antibiotic resistance.
Here are some other things you can do to help manage impetigo and stop it spreading:
Wash sores with salty water (1 teaspoon of table salt dissolved in a cup of hot water and left to cool) 2 to 3 times a day. Pat dry, using a new or single use towel each time, then apply the antibiotic cream as prescribed.
Cover sores with waterproof dressings to prevent the spread of infection. Throw all dressings in the bin straight after you take them off and wash your hands.
The affected area can become irritable and itchy. It is important not to scratch it because it can make the impetigo spread and get worse.
Practice good hand hygiene and keep your fingernails cut short.
PREVENTION
Most people are no longer contagious after 48 hours of treatment, or once their sores have dried and healed. Avoid childcare, school or work until you are no longer contagious. To minimize the risk of impetigo spreading, it’s also best to:
Avoid touching the sores
Wash hands regularly, especially after applying cream to the sores
Keep children out of childcare, playgroup or school until their sores have dried up
Avoid sharing anything that encounters the skin, such as face cloths, towels, clothes and bath water
COMPLICATIONS
Complications of impetigo are rare. However, sometimes the infection can spread to the lymph nodes (lymphadenitis), or to a deeper layer of skin (cellulitis).
DIFFERENTIAL
Impetigo, a bacterial skin infection, can be confused with various other conditions. Differential diagnoses include bacterial infections like erysipelas, staphylococcal scalded skin syndrome, and necrotizing fasciitis. Additionally, fungal infections (candidiasis, tinea), parasitic infestations (scabies), and viral infections (chickenpox, herpes simplex) can mimic impetigo. Other conditions to consider are drug reactions, atopic dermatitis, contact dermatitis, discoid lupus, and ecthyma.
