What is Impetigo?
Impetigo is a contagious bacterial skin infection on the surface of the skin which is most common in young children although it can occur in all ages. It is a very common skin condition seen by Dermatologists in children. Impetigo is characterised by pustules and honey-coloured crusted erosions which can make the skin sore and itchy. Forms of impetigo include nonbullous impetigo (impetigo contagiosa), bullous impetigo and ecthyma.
What causes Impetigo?
Impetigo is caused by the bacteria Staphylococcus aureus (Staph) which spreads from person to person by skin-to-skin contact, and so is very common in school-age children. It can also occur from other bacteria such as Streptococcus. The germs can pass on bedding, clothes and towels and can spread fast. Impetigo can be acquired through germs in a hospital or community. These germs often take advantage of damaged skin such as cuts, grazes, insect bites, head lice, scabies, cold sores or eczema. Impetigo is more frequent in warm and humid weather. Certain diseases, such as eczema and diabetes as well as some medications can make people more susceptible to impetigo.
Who is at risk of Impetigo?
While impetigo is more common in children, in adults it tends to occur in those with low immunity to the bacteria or in parents with young children. Impetigo can affect people of all races. It occurs more frequently in tropical climates and where there are crowded conditions or poor hygience.
What are the symptoms of Impetigo?
Impetigo symptoms start off as a rash of pustules that can break easily. The pustules tend to occur in circular red patches which are also associated with honey-coloured crust. The condition will often appear on exposed areas of skin such as the face and hands. The affected area starts off as small patches which gradually get bigger and may spread. If the infection is treated early then most cases of impetigo resolve without long-term problems. As the patches eventually heal, they should not leave scars but they may leave a redness in the affected area for some time after the pustules have gone. In rare cases the bacteria affects deeper skin tissue causing cellulitis, or can have systemic effects on the kidneys or heart.
How does a Dermatologist diagnose Impetigo?
A Dermatologist will diagnose impetigo based on the appearance of the condition. A bacterial swab is usually taken to determine the bacteria that is present and also which antibiotics that bacteria is sensitive to, and so will respond to that treatment. The Dermatologist may also take a swab of the nose, axilla and groin to check for underlying Staphylococcus carriage if cases are resistant.
How do you treat Impetigo?
A Dermatologist treats impetigo by prescribing the appropriate antibiotic. This is often commenced before the bacterial swab has been reported and can then be altered if needed once the antibiotic sensitivities are available. Gentle bathing of the area usually with an antibacterial preparation such as Dermol 500 or topical antiseptic creams or ointments can make the area affected skin more comfortable and hasten healing. If there is an underlying skin conditions such as eczema then treating this in conjunction with the impetigo is also very important.
In more severe cases, where there are multiple patches or larger areas of skin, a Dermatologist may prescribe a one week course of oral antibiotics such as dicloxicillin or flucloxacillin, depending on the sensitivities of the underlying bacteria, to help clear the infection.
Personal hygiene is extremely important with impetigo including keeping nails short and clean, avoiding scratching or picking of the lesions. Towels and clothing should not be shared with other members of the family and sheets should be washed regularly. Children should be kept home until crusted and weeping areas have cleared to avoid transmission to other children.
If Staphylococcus is found with the nose swab then staphylococcal eradication programme should be implemented which involves topical treatment with a specific ointment and/or antiseptic washes. If the impetigo is recurrent than other members of the family do need to be examined, including the dog, as they may be a reservoir causing reinfection of the patient.
If you think that one of your children may be suffering from Impetigo then book a dermatology consultation with one of our Paediatric Dermatologists by calling 020 7183 4565 or emailing the clinic at doctor@LSAH.co.uk.
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