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U of M on Impetigo

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Impetigo: Symptoms and Treatment

Impetigo is a common skin infection that, while anyone can develop, most occurs in children. Impetigo is contagious and usually causes skin rashes on the face, particularly on or around the mouth and nose.

Causes of Impetigo

Two bacteria cause impetigo: Staphlococcus aureus, commonly known as staph, and streptococcus pyones, also known as strep.

Skin injuries are common entry points for impetigo bacteria. Adults often contract impetigo through skin irritation caused by another skin condition. Children are often infected through scrapes, cuts, abrasions and insect bites. Children can also develop impetigo on their skin in areas that don't have obvious signs of scraping, cuts or other damage.

Impetigo Types and Symptoms

Impetigo symptoms differ depending on the nature of the infection. Here is a look at the three different types of impetigo:

Bullous impetigo is usually a disease of infancy, occurring in children under the age of two. Unlike impetigo conagiosa, bullous impetigo appears in the form of blisters on the arms, legs and torso. Bullous impetigo blisters are filled with fluid that forms a crust after the blister bursts. Redness and itchiness usually accompany the blisters.
Ecthyma impetigois more serious than the other two types of impetigo. It infects the secondary layer of skin (the dermis) in addition to surface skin. Ecthyma sores are painful. Usually developing on the legs and feet, the sores ulcerate and crust over with a hard yellow crust. Scarring from ecthyma sores can be expected after sores heal.
Impetigo contagiosa is the most common type of impetigo. Symptoms typically begin with red sores around the mouth and nose. Sores can, however, develop anywhere on the face. Impetigo contagiosa sores are not painful, but they do itch. As the infection develops, the sores rupture and ooze pus that crusts over the sore. Once the crust falls off, the sore leaves a red mark on the skin. Over time, the red mark fades away. Impetigo contagiosa will not leave permanent scars.

Impetigo Risk Factors

Children between the ages of two and six have the highest risk of developing impetigo. Because children's immune systems are still developing throughout childhood, young children are most at risk of developing staph and strep infections.

The elderly, people on immunosuppressant medication and people with immune system disorders also have a greater than normal risk of developing ecthyma impetigo.

Other factors that increase the risk of impetigo include:

chronic dermatitis
direct contact with someone infected with impetigo
participating in sports during which athletes directly touch each others' skin
warm, humid environments.

Impetigo is very contagious. Touching or scratching itchy sores and then touching other parts of the body spreads the disease.

Similarly, person-to-person transmission of impetigo results when touching items that have come into contact with the sores, such as clothing, toys, bed sheets, pillows and towels.

Impetigo spreads rapidly in areas where large numbers of people are in close contact, especially areas where children congregate, such as playschools and daycares.

Impetigo Treatment

Treatment for mild impetigo is usually limited to gently cleaning the sores and carefully removing sore crusts. A prescription antibiotic ointment called mupirocin can also be administered as part of impetigo treatment.

Severe cases of impetigo may require oral antibiotics. However, several strains of staph, one of the two bacterial causes of impetigo, have become increasingly resistant to common antibiotics. Identifying the strain of staph causing antibiotic resistant impetigo helps determine which antibiotics are most effective.

Complications of Impetigo

Impetigo complications are rare. Permanent scarring is rare, except in the case of ecthyma. Some darkening or lightening of affected skin can occur after impetigo sores heal.

A more serious complication that exists with impetigo is cellulites, a rare bacterial infection of the tissues directly under the skin. Without treatment, cellulites can spread to the lymph nodes and becomes a life-threatening condition.

When impetigo results from streptococcal bacteria, kidney inflammation can occur. The kidney infection is called poststreptococcal glomerulonephritis, or PSGN. Most cases of PSGN respond to treatment, but some cases can result in kidney failure.

Symptoms of PSGN develop approximately two weeks after the impetigo infection and include:

abnormally low urination
blood present in urine (hematuria)
facial swelling
high blood pressure
stiff/painful joints.

Impetigo Prevention

Proper hygiene and wound care reduce the risk of developing impetigo. Scrapes, cuts and insect bites should be washed immediately to lower the risk of infection.

During an impetigo infection, regular hand washing helps prevent the infection from spreading. The infected person's clothes should be washed regularly, as should bed linens and towels.

Because impetigo spreads easily when people scratch itchy sores, infected people should make an effort not to scratch themselves. Children's nails should be cut short to minimize scratching. Mittens or socks over the hands can also prevent infants from scratching impetigo sores.

Resources

Mayo Foundation for Medical Education and Research (October 5, 2006). Impetigo. Retrieved April 3, 2008, from the Mayo Clinic Web site:
www.mayoclinic.com/health/impetigo/DS00464/DSECTION=1.

Rockoff, A. (Updated September 6, 2007). Impetigo. Retrieved April 3, 2008, from the MedicineNet Web site:
www.medicinenet.com/impetigo/article.htm.

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