Impetigo: Treatment, symptoms, and causes

Impetigo is a highly contagious skin infection that is most likely to affect children aged from 2 to 5 years. The first sign is a patch of red, itchy skin.

In northern Europe, northern America, and Canada, it is the most common bacterial skin infection in children, but it can happen at any age. It is more common where people live in confined environments, such as army barracks, or in warm, humid climates.

Impetigo is rarely serious and usually resolves on its own within 2 weeks. However, complications sometimes occur, so a doctor may prescribe an antibiotic ointment or oral antibiotics.

Fast facts on impetigo

Here are some key points about impetigo. More detail is in the main article.

Impetigo is a contagious skin infection that is most common in children.

It is caused by Staphylococcus aureus or Streptococcus pyogenes bacteria

Symptoms normally go away without treatment, but this depends on the type of impetigo and the severity of symptoms

Treatment

infected impetigo <br>Image credit: Åsa Thörn 2011</br>
Impetigo can be successfully treated, but without treatment, it can become infected, and complications may result.
Image credit: Åsa Thörn 2011

Treatment for impetigo aims to speed up healing, improve the skin’s appearance, and prevent complications and the spread of infection.

The type of treatment will depend on the type of impetigo and the severity of symptoms.

If the infection is mild, a doctor may only recommend keeping the skin clean.

A more severe infection may need treatment with antibiotics.

Topical antibiotics

Topical antibiotics are applied directly onto the skin. The doctor might prescribe a mupirocin ointment, such as Bactroban. Before applying ointment, scabs need to be gently removed so that the antibiotic can get deep into the skin.

It is important to wash affected areas of skin with warm, soapy water before applying a topical antibiotic. If possible, latex gloves should be used when applying the cream. Hands should be washed thoroughly after.

The patient should respond to treatment within 7 days.

Oral antibiotics

These are prescribed when the impetigo is more widespread or if the patient has not responded to topical antibiotics. The type of antibiotic depends on the severity and infection, as well as other factors, including the patient’s medical condition and whether they have any allergies.

A course of antibiotics usually lasts about 7 days. It is important to complete the course, even if symptoms clear up early.

A child can go back to school 24 hours after antibiotic treatment starts, or when the sores have crusted and healed.

Natural remedies

Tea tree oil, olive oil, garlic, coconut oil, and Manuka honey have been said to relieve symptoms of impetigo, but more evidence is needed to confirm this.

Symptoms

The main symptoms of impetigo are red sores that burst and ooze before drying up.

The symptoms will depend on the type of impetigo.

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Types

There are two main types of impetigo: Non-bullous and bullous.

Non-bullous impetigo, or impetigo contagiosa

Around 70 percent of cases of impetigo are of this type.

Small red blisters appear around the mouth and nose, or, occasionally, in the extremities. The blisters soon burst and ooze either fluid or pus, leaving thick, yellowish-brownish golden crusts.

As the crusts dry, they leave a red mark which usually heals without scarring.

Although the sores are not painful, they may be very itchy. It is important not to touch or scratch them to prevent the infection from spreading to other parts of the body and other people.

In rare cases, symptoms may be more severe, with a fever and swollen glands.

Bullous impetigo

Bullous impetigo is caused by a certain strain of Staphylococcus aureus that secretes a type of toxin that targets the skin layer. It mainly affects infants under the age of 2 years.

The toxin attacks a protein that helps keep the skin bound together. As soon as this protein is damaged, the bacteria can spread rapidly.

Medium to large-sized fluid-filled blisters appear on the trunk, legs, and arms. The skin around the blister is red and itchy, but not sore. They often spread rapidly and eventually burst, leaving a yellow crust. The crust normally heals with no scarring.

The blisters are not painful, but they may be very itchy. Patients must try not to touch or scratch them.

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