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Advice for Impetigo
Impetigo is a common bacterial skin infection that is highly contagious, and is common in children although adults can also catch it. Bacteria like Staphylococcus aureus or Streptococcus pyogenes infect the outer layers of the skin, called the epidermis. Blisters or weeping sores appear around the face or hands and then crust over with yellowish scabs. The sores might be painful or itchy. It can sometimes infect other parts of the body as well Although impetigo is unpleasant and very contagious, it’s not a serious condition and can improve on its own over time. With treatment, impetigo can be cleared up more quickly within 7 to 10 days.
Impetigo may be classed as primary or secondary:
- In primary impetigo, the infection affects healthy skin.
- In secondary impetigo, the infection affects skin that is already 'broken' by another skin condition. For example, skin with eczema, psoriasis or a cut sometimes develops a secondary impetigo.
Factors that increase the risk of impetigo include:
- Age - most commonly seen in children ages 2 to 5.
- Close contact - it spreads easily within families, in crowded settings (e.g. schools), and from participating in sports that involve skin-to-skin contact.
- Warm, humid weather
- Broken skin - the bacteria that cause impetigo often enter the skin through a small cut, insect bite or rash.
- Other health conditions - other skin conditions, such as eczema are more likely to develop impetigo. People with diabetes or people with a weakened immune system are also more likely to get it.
There are two types of impetigo:
- Non-bullous impetigo – the most common type
- Bullous impetigo
Non-Bullous Impetigo
The symptoms of non-bullous impetigo begin with the appearance of red sores – usually around the nose and mouth but other areas of the face and the limbs can also be affected. The sores quickly burst leaving behind thick, golden crusts typically around 2cm across. The appearance of these crusts is sometimes likened to cornflakes stuck to the skin.
After the crusts dry, they leave a red mark that usually fades without scarring. The time it takes for the redness to disappear can vary between a few days and a few weeks.
The sores aren't painful, but they may be itchy. It's important not to touch or scratch the sores because this can spread the infection to other parts of the body, and to other people.
Other symptoms, such as a high temperature (fever) and swollen glands, are rare but can occur in more severe cases.
Bullous Impetigo
The symptoms of bullous impetigo begin with the appearance of fluid-filled blisters (bullae) which usually occur on the central part of the body between the waist and neck, or on the arms and legs. The blisters are usually about 1-2cm across.
The blisters may quickly spread, before bursting after several days to leave a yellow crust that usually heals without leaving any scarring.
The blisters may be painful and the area of skin surrounding them may be itchy. As with non-bullous impetigo, it's important not to touch or scratch the affected areas of the skin.
Symptoms of fever and swollen glands are more common in cases of bullous impetigo.
Complications
Rarely, complications of impetigo include:
- Cellulitis - this potentially life-threatening infection affects the tissues underlying the skin and eventually may spread to the lymph nodes and bloodstream.
- Kidney problems - one of the types of bacteria that cause impetigo can also damage the kidneys.
- Scarring - the sores associated with ecthyma can leave scars.
- Scarlet fever – a rare bacterial infection that causes a fine, pink rash across the body
- Guttate psoriasis – a non-infectious skin condition that can develop in children and teenagers after a bacterial infection
- Septicaemia (a type of sepsis) – a bacterial infection of the blood
- Staphylococcal scalded skin syndrome (SSSS) – a serious skin condition that looks like the skin has been scalded with boiling water
Impetigo occurs when the skin becomes infected with bacteria, usually either Staphylococcus aureus or Streptococcus pyogenes.
The bacteria can infect the skin in two main ways:
- Through a break in otherwise healthy skin – such as a cut, insect bite or other injury – this is known as primary impetigo
- Through skin damaged by another underlying skin condition, such as head lice, scabies or eczema – this is known as secondary impetigo
The bacteria can be spread easily through close contact with someone who has the infection, such as through direct physical contact, or by sharing towels or flannels. However, these bacteria are also common in our environment, and most people who come in contact with them won’t necessarily develop impetigo. Some people normally carry staph bacteria on the inside of their nose. They may get an infection if the bacteria spreads to their skin.
As the condition doesn't cause any symptoms until four to 10 days after initial exposure to the bacteria, it's often easily spread to others unintentionally.
Children and people with diabetes or a weakened immune system – either due to a condition such as HIV or a treatment such as chemotherapy – are most at risk of developing impetigo.
Impetigo isn't usually serious and often clears up without treatment after two to three weeks. Treatment is often recommended as it can help clear up the infection in around seven to 10 days and reduce the risk of the infection being passed on to others.
If impetigo is confirmed, it can usually be effectively treated with antibacterial topical creams/ointments. It can be applied directly to the sores two to three times a day for five to 10 days. If the infection is being caused by an underlying skin condition, such as eczema, this may also need to be treated.
At Pharmacinta, we have a number of different topical antibacterial agents to help manage your symptoms. These include Bactroban, Fudicin and Fucidin H preparations.
Tell your doctor if the initial treatment for impetigo does not work. A possible cause for this is if the germ (bacterium) causing the infection is resistant to the prescribed treatment. A switch to a different antibiotic is sometimes needed if the first does not work. Sometimes your doctor will take a swab to see which germ is causing the infection. A swab is a small ball of cotton wool on the end of a stick which is used to obtain mucus and cells. This sample is examined under a microscope in a laboratory. The result will help guide the best choice of treatment.
For minor infections that haven't spread to other areas, you could try treating the sores with an over-the-counter antibiotic cream or ointment. Placing a nonstick bandage over the area can help prevent the sores from spreading. Avoid sharing personal items, such as towels or athletic equipment, while contagious.
Antibiotic tablets may be prescribed if the infection is more severe and widespread, or if the symptoms don't improve after using antibiotic cream. These usually need to be taken two to four times a day for seven days.
Frequently Asked Questions
Since impetigo is very infectious, it’s important not to share creams or towels with someone who has it. It’s also very important to wash your hands thoroughly and wipe down any toys with detergent and water if your children have impetigo.
Hygiene is key to controlling impetigo’s spread. To avoid spreading the infection to other areas of your body and to other people: keep cuts, scratches and insect bites clean by washing them with warm water and soap; get treatment for skin conditions, like eczema
The open sores are highly contagious. Scratching the sores can spread the infection from one place on your skin to another, or to another person. The infection can also spread from anything touched by a person with an impetigo infection.
Impetigo is highly infectious but with adequate antibiotic treatment, should stop being infectious after around 24 hours.
Like impetigo, cold sores are blisters that form around your mouth. You might also see them on your nose or fingers. Cold sores are caused by the herpes simplex virus (HSV). This virus comes in two forms: HSV-1 and HSV-2. Usually, HSV-1 causes cold sores, while HSV-2 causes genital herpes.
Ringworm is a fungal infection of the skin. The name refers to the ring-like shape of the red, raised skin patches it produces. Unlike impetigo, ringworm doesn’t cause yellow crusting. Ringworm can be itchy and annoying. Good hygiene can help prevent it or keep it from coming back.
Erysipelas is a bacterial infection that affects the upper layers of skin. It’s caused by the same strep bacteria that are responsible for strep throat. Similar to impetigo, these bacteria sneak into the skin through an open wound or crack. Erysipelas causes blisters on the face and legs. Other symptoms include a fever and chills.
Eczema isn’t an infection. Instead, it can be a reaction to substances in your environment, like detergent, metal, or latex, or it may be associated with allergies or asthma Symptoms of eczema include: red, itchy skin, dry skin
Children are more likely to develop impetigo, as well as people with diabetes or a weakened immune system – either due to a condition such as HIV or by having chemotherapy. It spreads very easily so living in close contact with someone who has impetigo can increase the risk. It can spread easily in schools and nurseries.
<p>After having treatment, see a GP if: </p><p> 1. The rash has not improved within a week of using your prescribed medication </p><p> 2. The rash is spreading or becoming painful, swollen or leaking discharge </p><p> 3. You feel unwell e.g. temperature or feel dizzy, shivery and weak </p><p> 4. You have a compromised immune system </p>
Impetigo starts as red sores or blisters that burst and leave crusty yellow or brown patches that can look like cornflakes stuck to your skin.
Your impetigo sores should be kept dry. Wash them every 8-12 hours then apply a clean waterproof dressing. Using saline solution or salty water can also help to dry them out.
No. Impetigo usually goes away within a few weeks. If you’re taking an antibiotic, you should see a response within 3-10 days.
As with any infection, impetigo can spread to other parts of the body if left untreated. Typically, these complications are more common in adults. Some possible secondary conditions include cellulitis, an infection of the tissues beneath the skin, and sepsis, which is a critical condition in which the bloodstream becomes infected. Seeking treatment at the first sign of symptoms can help to reduce the risk of complications.
