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Impetigo facts
- Impetigo is a bacterial infection of the surface of the skin.
- Impetigo is more common in children than in adults.
- The two types of impetigo are non-bullous and bullous impetigo.
- Impetigo is contagious and is caused by strains of both
staph and
strep bacteria.
- Impetigo is not serious and is easy to treat with either prescription topical or oral antibiotics.
Scarring is very rare.
What is impetigo? What causes impetigo?
Impetigo (pronounced im-puh-TIE-go) is a contagious, superficial infection of the skin caused by
Staphylococcus (staph) and
Streptococcus
(strep) bacteria. Impetigo is more common in children (especially 2-
to 5-year-olds) than in adults. Impetigo is most likely to occur in
warm and humid environments and is most commonly spread by close contact
(such as family members).
What are the types of impetigo, and what are impetigo symptoms and signs? What does impetigo look like?
There are two forms of impetigo:
- Non-bullous impetigo: This is the more common form, caused by
both staph and
strep bacteria. This form initially presents as small red papules
similar to insect bites. These lesions rapidly evolve to small blisters
and then to pustules that finally scab over with a characteristic
honey-colored crust. This entire process takes about one week. These
lesions often start around the nose and on the face, but less frequently
they may also affect the arms and legs. At times, there may be swollen
but non-tender lymph nodes (glands) nearby.
- Bullous impetigo: This form of impetigo is caused only by
staph bacteria. These bacteria produce a toxin that reduces cell-to-cell
stickiness (adhesion) causing separation between the top skin layer
(epidermis) and the lower layer (dermis). This leads to the formation
of a blister. (The medical term for blister is
bulla.) Bullae can appear in various skin areas, especially the
buttocks and trunk. These blisters are fragile and contain a clear
yellow-colored fluid. The bullae are delicate and often break and leave
red, raw skin with a ragged edge. A dark crust will commonly develop
during the final stages of development. With healing, this crust will
resolve.
Is impetigo contagious?
Impetigo is contagious, primarily from direct contact with someone who
has it but sometimes from towels, toys, clothing, or household items.
Impetigo often spreads to other parts of the body. This is particularly
common with impetigo in children. There may be mini epidemics in
day-care centers. Bacteria that cause impetigo may enter through a break
in the skin, such as that which comes from cuts and scrapes. A common
toddler impetigo experience is the development of impetigo at the nasal
openings inflamed by the prominent nasal drainage associated with a
cold. In this situation, skin integrity is often disrupted by the
continuous covering of purulent nasal discharge. Adults often develop
impetigo from close contact with infected children. Heat, humidity, and
the presence of
eczema predispose a person to developing impetigo. Recurrent impetigo infections may be associated with
staph or strep bacteria residing in the nose and spreading from to other parts of the skin.
How is impetigo diagnosed?
Diagnosing impetigo is generally straightforward and based on the
clinical appearance. Occasionally, other conditions may look something
like impetigo. Infections such as tinea ("
ringworm") or
scabies
(mites) may be confused with impetigo. It is important to note that not
every blister means an impetigo infection. At times, other infected
and noninfected skin diseases produce blister-like skin inflammation.
Such conditions include
herpes cold sores,
chickenpox,
poison ivy, skin
allergies, eczema, and
insect bites.
Secondary infection of these other skin lesions may sometimes occur.
Medical evaluation and occasionally culture tests are used to decide
whether topical antibacterial creams will suffice or whether oral
antibiotics will be necessary.
What is the treatment for impetigo?
Impetigo is not serious and is very treatable. Mild impetigo can be
handled by gentle cleansing, removing crusts, and applying the
prescription-strength antibiotic ointment
mupirocin (Bactroban). Nonprescription
topical antibiotic ointments
(such as Neosporin) generally are not effective. More severe or
widespread
impetigo, especially of bullous impetigo, may require oral antibiotic
medication. In recent years, more
staph germs have developed resistance to standard antibiotics. Bacterial
culture tests can help guide the use of proper oral therapy if needed.
Antibiotics which can be helpful include
penicillin derivatives (such as Augmentin) and cephalosporins such as
cephalexin (Keflex). If clinical suspicion supported by culture results show other bacteria, such as drug-resistant
staph (methicillin-resistant
Staphylococcus aureus or
MRSA), other antibiotics such as clindamycin or
trimethoprim-sulfamethoxazole (Bactrim or Septra) may be necessary. Treatment is guided by laboratory results (culture and sensitivity tests).
What are possible complications of impetigo?
One potentially serious, but rare, complication of impetigo caused by strep bacteria is
glomerulonephritis,
a condition producing kidney inflammation. Many specialists are not
convinced that treating impetigo will prevent glomerulonephritis from
occurring.
Will impetigo leave scars?
Because the crusts and blisters of impetigo are superficial, impetigo
generally does not leave
scars. Affected skin looks red for a while after the crusts go away, but this redness fades in a matter of days to weeks.
Can impetigo be prevented?
Routine hand washing with soap and warm water is an important and effective mechanism to prevent the spread of impetigo.
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