Impetigo

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What is impetigo?

Impetigo is a bacterial infection of the superficial layers of the skin, that is highly contagious and is more commonly seen in children. The face, arms, and legs are usually affected, while the groin and the armpits may also be involved. It is more common in regions with a hot and humid climate.

Is impetigo a medical emergency?

Impetigo is not a medical emergency.

Types of impetigo

Impetigo is of the following types:

  • Nonbullous Impetigo or contagious impetigo or impetigo contagiosa
  • Bullous Impetigo: More common in children below the age of 2 years
  • Ecthyma: A variant of non-bullous impetigo with deep ulceration

Causes of impetigo

It is caused when there is bacterial colonization of the superficial layers of the skin (epidermis) by bacteria such as staphylococcus aureus (most common) or streptococcus pyogenes. The colonization of the skin with the bacteria happens when the intact structure of the skin is broken due to scratching, or other skin infections, scabies, trauma, burns, insect bites, or surgery. It is highly contagious and contact with the sores and lesions, or the secretions from these lesions result in the disease being transmitted.

Risk factors for impetigo

The following are the risk factors for impetigo:

  • Age: Children below the age of 5 years are more commonly affected
  • The warm and humid climate
  • Close contact with other kids as seen in creches, or playschools, child care centers, etc
  • Sports such as wrestling, kabaddi, judo where there is a skin to skin contact
  • Broken skin: As seen in trauma, scratching, insect bites, burns, scabies, varicella, surgery, etc
  • Immunocompromised individuals: HIV/AIDS, chemotherapy, steroid therapy

MRSA which is Methicillin-resistant Staphylococcus aureus is a severe and stubborn bacteria that is resistant to a lot of antibiotics and it can cause this disease in the following cases:

  • Health care and hospital workers
  • Hospitalization for a prolonged period
  • Residents of long term care facilities
  • Having chronic indwelling catheters or medical devices

Signs & symptoms of impetigo

The following are the symptoms and signs of impetigo:

  • Red sores
  • Sores rupture and ooze a serous liquid for a few days
  • Once the oozing stops a yellowish-brown or honey-colored crust is formed
  • Sores are more often seen around the nose, lips and the mouth
  • The infection can spread to any part of the body
  • Fluid-filled blisters are seen in the bullous impetigo, which quickly burst and then forms a crust

Investigations

Investigations are usually not required for the diagnosis of this disease however the following may be done through:

  • Bacterial culture and sensitivity: To identify the presence of MRSA
  • Serum Immunoglobulins: If recurrent impetigo is seen; it is done to eliminate immunodeficiency
  • Bacterial culture of the nares: Is done to check if the individual is a carrier of aureus

Diagnosis of impetigo

Diagnosis of impetigo is done based on medical history, clinical evaluation, and results of the investigations if any.

Impetigo treatment options

Treatment of impetigo is aimed at local wound care and the elimination of the infection.

A. Medical management

Medical management of impetigo may include:

  • Topical antibiotic: Such as mupirocin, fusidic acid, retapamulin; if this disease is limited or localized
  • Systemic antibiotics: If there is extensive involvement; it is also given to athletic teams, family members, etc

B. Role of diet/exercise/lifestyle changes/preventive measures

Some measures that can help in the prevention of this disease may include:

  • Children with this disease to avoid contact with other children, and avoid school and daycare for at least 24-48 hours after antibiotic treatment has been started.
  • Taking proper care of wounds by washing with gentle soap and warm water, and applying a topical antibiotic.
  • Washing the clothes, and bed linen of an infected individual separately and every day.
  • Wearing gloves while attending to individuals affected by this disease.
  • Keeping the nails of children trimmed and clean.
  • Practicing and teaching children to practice good hand hygiene.

Complications of impetigo

The complications of impetigo may include:

  • Kidney dysfunction
  • Post streptococcal glomerulonephritis
  • Staphylococcal scalded skin syndrome (SSSS)
  • Osteomyelitis
  • Septic arthritis
  • Cellulitis
  • Erysipelas
  • Urticaria
  • Septicemia

Prognosis

The prognosis for this disease that is diagnosed early and treated promptly is excellent. Complications may occur more commonly in very young children or infants who are also immunocompromised.

When to contact the doctor or hospital/how to identify the emergency or complications?

It is advisable to seek immediate medical attention if the symptoms and signs of this disease are noticed.

Indications for hospitalization if required

Hospitalization is not required for the management of this disease unless severe complications develop.

Suggested clinical specialist/departments to consult for this condition

It will be attended by specialists from the department of dermatology and pediatric dermatology.

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