Impetigo: Everything You Need to Know

"Clinically it is impossible to distinguish staphylococcal impetigo from streptococcal" indicate experts from the Spanish Association of Pediatrics. Let's see more about this disease.
Impetigo: Everything You Need to Know

Written by Maite Córdova Vena, 11 September, 2021

Last update: 11 September, 2021

Neonatal acne, seborrheic dermatitis, heat rash, erythema toxicity, and impetigo are some of the most common skin conditions. The latter can affect newborns and young children 2 to 6 years old.

Impetigo is a highly contagious, infectious disease. For this reason, it is positioned as one of the main reasons for pediatric consultation, as confirmed by several specialized sources.

Types and symptoms

Impetigo can affect any part of the body. However, it most commonly affects the face, arms and legs.

There are two types of impetigo: non-bullous and bullous. In both, the lesions can cause itching and discomfort or pain.

Bullous impetigo

Bullous impetigo is the most prevalent type in young children. It most often affects the face (around the mouth and nose) and the extremities.

The lesions (which are superficial blisters in groups of 3 or 6) are of variable size and can last from a few days to several weeks. The content is transparent at first, but then turns cloudy.

Blisters break easily and can heal spontaneously without scarring. But there are cases in which they can produce residual hypopigmentation.

Blisters on the skin.
Impetigo blisters then give way to crusts that look like honey, which is why they are called “honeydew.”

Non-bullous impetigo

Non-bullous impetigo accounts for the majority of cases; more than 70%, according to experts from the Spanish Association of Pediatrics. The lesions usually appear in areas that have had trauma (such as an insect bite or a superficial wound) and are small erythematous papules.

Papules evolve into blisters with thin walls and an erythema base. They break easily and exude an exudate that later dries. When drying, yellowish crusts form. Children transfer lesions by scratching, forming satellite scabs.

Causes

Impetigo is an infection that can be caused by bacteria, such as Streptococcus pyogenes or Staphylococcus aureus, or both at the same time. It should be noted that these pathogens are also the cause of other skin diseases, including cellulite.

On the other hand, impetigo is easily spread by direct contact. Which is why it’s so contagious. In fact, it can be spread not only through contact with injuries, but also through clothing, towels, sheets, and other objects.

As it produces various uncomfortable symptoms, babies and children tend to scratch the lesions, which contributes to the spread.

Risk factor’s

According to experts from the Mayo Clinic, in addition to age and direct contact, some risk factors for impetigo can be mentioned:

  • Heat
  • Humidity
  • Poor hygiene
  • Have a weak immune system
  • Having chronic diseases, such as diabetes
  • Having skin conditions, such as atopic dermatitis
  • Suffering skin lesions: cuts, insect bites, rashes

Diagnosis

The diagnosis of impetigo is clinical. This means that the doctor can diagnose the disease by performing a physical examination of the signs and symptoms. As the injuries are quite characteristic, the process does not usually take long.

Although it is not usually necessary to request laboratory tests, in some cases the doctor may order a bacterial culture to rule out whether the cause of the infection is resistant bacteria. This will be important when defining the most appropriate treatment.

When the infection occurs repeatedly, the doctor may take a smear from the nose and send it to the laboratory for analysis. Thus, you’ll know if the person is a nasal carrier of staphylococci or streptococci.

Culture for staphylococci in impetigo.
The culture in impetigo is reserved for resistant cases or for etiological doubts.

Treatment for impetigo

Treatment of impetigo consists of maintaining good hygiene, applying topical antimicrobials (such as fusidic acid and mupirocin), and the use of systemic antibiotics. Of course, these measures are adapted as the case may be.

As shown in the scientific literature, for the treatment of bullous impetigo, washing with soap and water or chlorhexidine is usually indicated. And depending on the extent of the lesions, topical antibiotics (such as chlorohydroxyquinoline, mupirocin, fusidic acid, and bacitracin) or systemic antibiotics (the latter are usually reserved for extensive lesions) may be prescribed.

Experts warn that when the patient is a nasal carrier of staphylococci, preparations containing propylene glycol should not be used, because it irritates the mucous membranes. In its case, topical antibiotics applied in the nostrils are used.

While it’s true that there are cases that resolve themselves spontaneously, this doesn’t exempt from maintaining proper hygiene and being attentive to changes in the baby’s or child’s skin. Of course, in case of doubts, it’s always best to consult with the pediatrician.

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