A highly contagious skin infection causing red sores caused by a bacterial infection.
One does not usually have symptoms until four to ten days later after exposure spreading the infection without knowing.
Impetigo infection usually self-resolves within two to three weeks; however, with effective treatment, infection should resolve in seven to ten days.
While impetigo generally affects the upper layer of the skin, secondary infections and complications can occur, which may be life-threatening if left untreated.
It is very common in children since their immune system is still developing and they have a lot of physical contact with others.
There are two types:
Non-bullous impetigo (common)
Bullous Impetigo
Table 1. Non-bullous and bullous impetigo
Non-bullous
Bullous
Source: NICE 2,4, NHS inform 3
Initially appears as red sores; these quickly burst to form thick golden crusts.
Crusts dry and leave red marks that fade over a few days to a few weeks.
Most commonly occur around the nose and mouth, but also on other areas of the face and limbs.
Sores may be itchy, but not painful.
Systemic infection is rare.
Most common form; seen in 70% of cases and most common in children aged 2 to 5 years.
Presents initially as small (0.5–2cm across) fluid-filled blisters, known as bullae.
Bullae quickly spread and burst after several days to form yellow crust.
Most commonly occur on the trunk or on limbs.
Blisters are formed when toxins released by causative bacteria cause a loss in cell adhesion in the epidermis. Blisters may be painful and surrounding area may be itchy.
Signs of systemic infection, lymphadenopathy and pyrexia, more common with bullous impetigo.
Less common form that can occur in all ages, but is more often seen in children below 2 years.
Cause
Bacterial infection:
Stapphlycoccus aureus
Streptococcus pyogenes, which may co-exist with S. aureus and methicillin-resistantS. aureus (MRSA)
Transmission occurs directly through close contact with an infected person (commonly via hands) or indirectly via contaminated objects (e.g. toys, clothes, towels).
Red sore around the mouth, nose, face or arms and legs, spread and burst quickly?
Infection with yellow weeping crusts 3-5cm?
Skin around busted sores becomes very itchy?
Bullous Impetigo:
Starts with Large painless, fluid-filled blisters red sores just above the waist, body or arms and legs (not head or neck), it spreads quickly then they bursts?
Infection with yellow weeping crusts 3-5cm?
Skin around busted sores becomes very itchy?
High temperature greater than 38°C (100°F) or over and/or chills and sweats longer than 72 hours?
Not share face cloths, towels or other personal care products to prevent infection. In addition, explain it is necessary to wash face cloths, sheets and towels at a high temperature to kill bacteria.
To prevent the spread in children, toys should be washed with detergent and warm water
Wash clothing, bed linen, all fluffy toys and towels at high temperature.
Do not scratch skin/pick it can spread the infection.
Wash sore with soap and water.
Wash all toys and wipe all contact surfaces.
Adults/children should not go to school/work until 48 hours after treatment or sore have dried up an/or until scabs or open areas have healed.
It is no longer infectious once patches crust over or following 48 hours of antibiotic treatment.
Not to share topical treatment (if multiple members of the same family are infected, then ensure cream is provided for each patient);
Stay away from school, childcare facilities or work until lesions are healed, dry and crusted over, or 48 hours after initiation of antibiotic treatment because of the highly contagious nature of the infection.
Not go to the gym or play contact sports.
Keep sores and blisters clean and dry — advise them to cover these in loose clothing of gauze bandages (this may be more difficult for lesions on the face) and to bathe lesions in warm water before applying creams to remove crusting where possible.
Keep wounds covered and when changing dressings, place in a separate plastic bag and dispose in the bin.
Not preparing food for other people if they are infected. Explain that food handlers are required by law to inform employers immediately if they have impetigo;
Cut children’s nails to prevent damage to infected sites and secondary infection.
Ensure optimal treatment of any pre-existing skin conditions (e.g. eczema, head lice, scabies or insect bites).
Treatment
To remove crusts:
Soak with a vinegar solution (1 tablespoon of white vinegar to a pint of water) for 15–20 minutes and apply to moist areas for about ten minutes several times a day, before gently wiping off the crusts.
To prevent spreading of lesions;
National Institute for Health and Care Excellence (NICE) guidance recommends managing impetigo and ecthyma through hygiene measures to help minimise the spread. Localised infection may be treated with topical hydrogen peroxide 1% or, if not suitable (i.e. if infection is close to the eyes or lesions show signs of infection)
The Pharmaceutical Journal, PJ, August 2023, Vol 311, No 7976;311(7976)::DOI:
10.1211/PJ.2023.1.191226
Please talk to your healthcare professional (i.e. Medical Doctor/Pharmacist) for further advice
Detailed Information
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