About Impetigo
Impetigo is a contagious bacterial skin infection that can be caused by different types of bacteria. Types of impetigo include:
- Nonbullous impetigo: This is the most common type of impetigo. It starts with clusters of red or discolored itchy sores that typically appear around the mouth and nose. These sores can rupture and develop into thick, honey-colored crusts.
- Bullous impetigo: This type of impetigo begins as fluid-filled blisters that usually occur on the trunk, between the neck and waist. These blisters enlarge quickly, burst, and become covered with a honey-colored crust.
It's important to note that impetigo can be mistaken for other skin conditions such as eczema, scabies, contact dermatitis, candidiasis, herpes simplex, and varicella-zoster. If you suspect you have impetigo or any skin condition, it's best to seek medical treatment for an accurate diagnosis and appropriate treatment.
Impetigo is a common skin infection caused by bacteria that invade the skin. The most common bacteria responsible for impetigo are Staphylococcus aureus and Streptococcus pyogenes. These bacteria can enter the skin through cuts, scrapes, or insect bites, causing infection.
Non-modifiable risk factors are factors that cannot be changed or controlled. In the case of impetigo, some non-modifiable risk factors include:
- Age: Children between the ages of 2 and 5 are more susceptible to impetigo due to their underdeveloped immune systems and close contact with other children in daycare or school settings.
- Climate: Warm and humid climates create an environment where bacteria can thrive, increasing the risk of impetigo.
- Skin conditions: People with pre-existing skin conditions like eczema or dermatitis have a higher risk of developing Impetigo because their skin barrier is compromised, making it easier for bacteria to enter.
Modifiable risk factors are factors that can be changed or controlled. Some modifiable risk factors for impetigo include:
- Personal hygiene: Good personal hygiene practices, such as regular handwashing with soap and water, can help reduce the risk of bacterial infections like Impetigo.
- Skin-to-skin contact: Close contact with someone who has Impetigo increases the risk of transmission. Avoiding direct contact with infected individuals can help lower the risk.
- Sharing personal items: Sharing towels, clothing, or other personal items with someone who has Impetigo can spread the infection. It's important to avoid sharing these items to reduce the risk.
By understanding both non-modifiable and modifiable risk factors for impetigo, individuals can take appropriate measures to prevent infection and reduce their chances of developing this common skin condition.
The initial symptoms of impetigo usually appear about 2 to 10 days after infection. The main characteristic of impetigo is the presence of blisters or sores that burst and ooze before eventually drying up. These blisters may start as small and then spread quickly.
- In non-bullous impetigo, which accounts for around 80% of cases, the blisters often join together and form a honey-colored crust as they burst and weep. This type of impetigo commonly affects the face and extremities.
- In bullous impetigo, there are fewer but larger blisters that may appear on the trunk of the body or even in the mouth. The blisters in bullous impetigo contain a clear or yellow fluid that may become cloudy or dark over time. Unlike non-bullous impetigo, bullous impetigo doesn't usually cause redness or swelling, and the blisters may stay longer without bursting.
Common symptoms of impetigo include:
- Small bumps or blisters that burst and ooze a clear liquid.
- Moist, tender, and red skin underneath the blisters.
- Formation of a honey-colored crust over the affected area (non-bullous impetigo).
- Itching in the affected area.
- Larger blisters that contain clear or yellow fluid (bullous impetigo).
As impetigo progresses or becomes more severe, additional symptoms may occur:
- Redness and swelling in the affected area.
- Fever and swelling of the lymph glands in the face or neck
In rare cases, complications can arise from impetigo. These complications are uncommon but can be serious. They include:
- Post-streptococcal glomerulonephritis: A potentially life-threatening kidney infection that occurs in about 15% of people with non-bullous impetigo.
- Sepsis: A severe bloodstream infection.
- Osteomyelitis: An infection in the bones.
- Arthritis: Inflammation of the joints.
- Endocarditis: An infection of the heart valves.
- Pneumonia: An infection in the lungs.
- Cellulitis: A skin infection that spreads to deeper tissues.
- Lymphadenitis: Swelling and inflammation of lymph nodes.
- Rheumatic fever: A condition that can cause problems with the heart, joints and brain.
It's important to note that complications are rare, but if new symptoms appear or if symptoms persist or worsen, it's essential to seek medical attention for further evaluation and treatment.
To diagnose impetigo, doctors may perform the following examinations, tests, and procedures:
- Visual Examination: A doctor can usually diagnose impetigo by visually examining the affected area of the skin. They will look for specific symptoms such as red sores that burst and develop honey-colored crusts.
- Medical History: The doctor may ask about any recent cuts, scrapes, insect bites, or other skin conditions that may be related to the development of impetigo.
- Swab Test: In some cases, the doctor may decide to do a swab test to identify the bacteria causing the infection. This involves gently swabbing the skin to collect tissue and fluid samples. These samples are then sent to a laboratory for testing.
Additional examinations, tests, and procedures may be performed to determine the type of impetigo:
- Culture Test: During early infection, a culture test can be done by collecting exudate or pus from an impetigo lesion. The sample is collected by gently rolling a moistened swab over the crust that forms after the pus thickens and hardens. This culture test helps identify the presence of Streptococcus pyogenes.
- Polymerase Chain Reaction (PCR): In the future, molecular methods such as PCR may be used for microbiological diagnosis of Impetigo. PCR can detect specific DNA sequences of bacteria and is highly sensitive and specific.
The general goals of treatment for impetigo are to eliminate the infection, relieve symptoms, prevent complications, and prevent the spread of the infection to other parts of the body or to other people. Treatment options for Impetigo may vary depending on the severity and type of infection.
Treatment may include:
Medications:
- Topical antibacterial ointments: These are applied directly to the affected area and can help kill the bacteria causing Impetigo. Examples include mupirocil and retapamulin. Topical antibiotics work by inhibiting bacterial growth and reducing inflammation.
- Oral antibiotics: In cases where impetigo is more severe or widespread, oral antibiotics may be prescribed. Examples include dicloxacillin, flucloxacillin, cefalexin, and trimethoprim/sulfamethoxazole (co-trimoxazole). Oral antibiotics work by killing bacteria throughout the body.
Self-care and health behavior changes:
- Cleaning the affected area: It is important to clean the affected area with soap and water several times a day to remove crusts and reduce bacterial load.
- Gently cleansing scabs: If there are any moist, yellow scabs present, they can be gently cleansed with a diluted hydrogen peroxide solution.
- Covering the area: To prevent spreading the infection to other parts of the body or to other people, covering the affected area with gauze and tape or a loose plastic bandage can be helpful.
- Good hygiene practices: Practicing good hygiene, such as washing hands frequently with soap and water, can help prevent the spread of Impetigo.
- Avoid scratching or picking at sores: Scratching or picking at Impetigo sores can worsen the infection and increase the risk of spreading it.
While most cases of Impetigo resolve without complications, there are potential risks to be aware of, especially in certain populations.
- Infants are more likely to develop complications such as inflammation of the kidneys (glomerulonephritis), rheumatic fever and infection of the blood (bacteremia).
- In rare cases, individuals with impetigo caused by Staphylococcus aureus can experience local and systemic spread of infection, leading to conditions like cellulitis (skin infection), lymphangitis (infection spreading through lymph vessels), or septicaemia (bloodstream infection).
It's important to note that these complications are not common but can occur. Every individual is unique, and prognosis may vary depending on factors such as age, overall health condition, specific type of Impetigo, and response to treatment. It's always best to seek medical advice from a healthcare professional for personalized guidance regarding your specific situation.