Impetigo in children and adults

Impetigo (or superficial pyoderma) is an infection of the skin that mainly affects children; It causes:

It is very common, especially in the summer months, and is highly contagious.
Impetigo infantile can affect the skin all over the body, but usually it occurs:

  • Face: around nose and mouth,
  • Neck
  • Scalp
  • Hands
  • Forearms
  • Legs
  • and in the diaper area (in newborns).

Pregnant women are more susceptible to skin diseases due to hormonal changes.
Young pregnant women may be affected by impetigo herpetiformis, a rare disorder that can occur in the third trimester of pregnancy – Rogerio Nabor Kondo et al. (Dermatologist, Assistant Professor of Dermatology at the Regional University Hospital of the North of Paraná – State University of Londrina (HURNP-UEL) – Londrina (PR), Brazil).
Impetigo herpetiformis also causes:

Impetigo can occur along with folliculitis called impetigo of the hair follicles or impetigo follicularis Bockhart, which is caused by Staphylococcus aureus.

There are two types of impetigo:
1. Bullous impetigo, which forms large blisters that are painless and filled with fluid.
2. Non-bullous impetigo, which is more contagious than the bullous and causes small blisters that break open quickly, leaving a yellow-brown crust.


Causes of impetigo

Impetigo is caused by bacteria:

  • Streptococcus pyogenes of group A
  • Staphylococcus aureus

Staphylococcus aureus is resistant to methicillin (MRSA) and is becoming an increasingly common cause.

There are usually many types of bacteria on the surface of the skin. If there is a skin lesion, the bacteria can enter the body and multiply. This causes infection and inflammation.
Skin wounds can be caused by:

  1. animal bites,
  2. lesions and injuries of the skin,
  3. Insect.

Impetigo can also form on healthy skin where no injury is visible.
It is most common in children living in unhealthy conditions, but can also occur in adults. It can develop after a cold or other viral illnesses, such as:

Impetigo can be transmitted to other people.
The infection can be transmitted through the liquid contents of the blisters when it comes into contact with injured skin.

Transmission can also occur through contact with objects previously touched by an infected person, for example:

  • Clothing
  • Bedclothes
  • Towels
  • Toy.

Who is at risk of infection?

  • Children and adolescents with eczema (atopic dermatitis) are more likely to develop impetigo.
  • People living in poor hygienic conditions.
  • Diabetics are more likely to contract this infection.
  • As with other highly contagious infectious diseases, people with immune system weakness (for example, AIDS) are at greater risk of developing impetigo.

Symptoms of impetigo

Among the symptoms there are:

  • One or more pus-filled blisters that tear easily.
  • Reddish skin in children or a crust where a blister has opened.
  • Blisters that sometimes cause itching on the skin.
  • Bubbles with yellow or honey-colored liquid contents.
  • Blood loss and crusts.
  • Rash that begins with dots on the skin, but spreads to other zones by scratching. For this reason, it is recommended to keep fingernails short.
  • Moist and soft crusts on:
    • Face
    • Lips
    • Ears
    • Eyes
    • Genital
    • Poor
    • Legs
  • The crusts spread to other areas.
  • Enlarged lymph nodes near the infected zone.

Diagnosis of impetigo

The diagnosis of impetigo is usually easy to make and depends on the clinical presentation.
Only rarely do other diseases show a similarity to impetigo.
The doctor may prescribe further examinations, such as:

  • analysis of the fluid of the vesicles or crusts (lesion culture),
  • Hemoculture.

It is important to remember that not all blisters indicate infection with this condition.

Differential diagnosis
Sometimes other infectious and non-infectious diseases also lead to inflammation with blistering on the skin.
These diseases include:

Erysipelas is a bacterial infection that affects the deeper areas of the skin (derma), while impetigo is limited to the uppermost layers of the skin.
Sometimes secondary infections can develop on these skin lesions. The medical evaluation and the results from bacterial cultures decide whether antibacterial creams are sufficient or whether taking antibiotics is necessary.

How to treat? Treatment of impetigo

Normally, impetigo is mild and often passes without treatment after two to three weeks.
If the crusts are present in several areas of the body, the infection will be difficult to cure on its own and requires medical attention
. If impetigo is confirmed by the doctor, effective treatment with antibiotics can be given, which is prescribed in the form of:

  • cream (local treatment),
  • Tablets.

With the therapy:

  • the infection would have to pass after about six to ten days;
  • also reduces the time a person is contagious.

Antibiotic ointments
Before applying an antibiotic cream, the affected area should be washed well with soap and water.
To prevent the risk of spreading infection, one should:

  • wash hands immediately after applying the cream,
  • wear protective gloves during treatment.

Pharmacological treatment
Antibiotic tablets (for oral use) may be prescribed:

  1. in case of severe and rapidly spreading infection,
  2. if local ointment treatment has been inadequate.

As a rule, a cycle of seven days is recommended for taking antibiotics.

Which topical antibiotics are recommended?

Three studies have shown that topical antibiotics are more effective than placebo in treating impetigo, according to Charles Cole and John Gazewood, doctors at the University of Virginia School of Medicine.

Topical antibiotics (ointments)
The majority of patients with a disease spread to smaller areas should use mupirocin (InfectoPyoderm) or fusidic acid (Fucidine) because they are effective and well tolerated.

Refobacin (active substance gentamicin) is indicated for skin infections such as:

  • Impetigo
  • Folliculitis
  • Eczema.

Sulmycin ointment with CelestanV contains, in addition to gentamicin, betametasone (cortisone), which can be helpful if the condition also causes itching.

Oral antibiotics Numerous scientific studies have compared different oral antibiotics
Two evaluations of scientific studies (George A, Rubin G. A systematic review and meta-analysis of treatments for impetigo. Br J Gen Pract. 2003;53:480–7) have shown that the following antibiotics had the same efficacy in the treatment of impetigo:

  • Penicillins with limited spectrum of action
  • Broad-spectrum penicillins
  • Cephalosporins
  • Macrolides

Penicillin V (phenoxymethylpenicillin) and amoxicillin were less effective than cephalosporins or amoxicillin/clavulanic acid (Augmentin).

Usually, doctors prescribe the following antibiotics for impetigo contagioso:

  • Dicloxacillin (Diamplicil) or Cefalexin for spread and persistent lesions.
  • Clindamycin (Zindaclin) or erythromycin (Infectomycin) in patients who are allergic to penicill.

Side effects of antibiotics taken orally may include:
1. stomach pain
2. nausea (feeling malaise) 3. vomiting
4. diarrhea (loose stools)

5. yeast infection, such as candida

When is the disease no longer contagious?

As long as the bubbles develop fluid, there is a risk of infection.
Impetigo loses its risk of infection 48 hours after starting treatment.
If the child is ill with impetigo, he can return to school or kindergarten in the following cases:

1. 48 hours after the start of antibiotic treatment
2. When the wounds no longer form blisters or crusts.

If symptoms have not improved within a week of starting treatment, the GP should be consulted for a check-up to consider other treatment options.

Natural remedies for impetigo

  • Do not touch crusts Do not scratch the affected areas of the skin, so as not to transmit the disease to other parts of the body.
  • An easy-to-remove bandage can be applied to the affected areas to prevent the blisters from spreading to other areas.
  • Prepare a natural antibiotic solution with a spoonful of white vinegar on two cups of water and wet the affected skin with it for fifteen minutes. This remedy serves to contain the infection and soften the crusts.
  • One can apply olive oil, clove essential oil, tea tree oil or myrrh locally to the affected skin areas to kill the bacteria causing the infection.
  • Garlic – known for its antibiotic properties. Garlic helps reduce symptoms and supports the immune system.

    • Clean the area in question.
    • Rub the area with garlic.
    • Create a bandage.
    • Remove the bandage after two hours.
    • Repeat the operation twice a day.
  • Impetigo irritates the skin. Therefore, extracts with anti-inflammatory properties, such as tea tree oil and echinacea, are helpful.
    Tea tree oil is a versatile disinfectant that fights microbes on the skin when a few drops are added to the bath water.
    An echinacea-based cream on the affected areas can help fight the infection.

Homeopathic remedies for impetigo contagiosa
A combination of ingredients of herbal and homeopathic remedies helps balance and keep skin moist to favor the natural healing process. The most commonly used products are:
1. Natrium muriaticum,

2. Mezereum,

3. Tarentula,

4. Aurum Metallicum.

Prevention of recurrent impetigo

  • Hand washing with warm water and soap is an important precaution to prevent recurrence of impetigo.
  • For children, it is recommended not to go to the beach for a few days, because sand, moisture and salt water can aggravate the disease.
  • One should not expose oneself to the sun, spots may form on the skin where the crusts are.

Possible complications of impetigo

1. Renal insufficiency (poststreptococcal glomerulonephritis)
2. Many spots after impetigo (in children)

3. Permanent skin damage and scarring (very rare)

4. Spread of the infection to other parts of the body (common)
5. Osteomyelitis 6. Septic arthritis
7. Pneumonia
8. Sepicaemia
9. Infectious cellulitis

How long does impetigo last? Can it be revived?

The wounds of impetigo heal slowly.
Scarring is rare.
The cure rate is very high, but recurrence in young children is common.

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