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Impetigo Details

Impetigo

Understand The - Symptoms, Causes, Tests & Treatment

Impetigo is a common, highly contagious bacterial skin infection.It mostly affects young children and infants. But people of any age can get it from contact with someone who is infected.Most impetigo is caused by Staphylococcus aureus bacteria. The infection isn’t usually serious, but sometimes complications may develop.

Common symptoms of impetigo --

Reddish spots on the skin, often clustered around the nose and lips, are the first sign of the most common type of impetigo.
The sores quickly grow into blisters, ooze and burst, and then form a yellowish crust. The crust is often described as honey-colored. The clusters of blisters may expand to cover more of your skin.
The sores are unsightly, itchy, and occasionally painful. After the crust phase, they leave red marks that fade without leaving scars.
Infants often have a less common type of impetigo, with larger blisters around the diaper area or in skin folds. These fluid-filled blisters soon burst, leaving a scaly rim called a collarette.
Impetigo can be uncomfortable. Occasionally, it may involve swollen glands in the area of the outbreak. Fever and swollen glands can occur in more severe cases.

A rarely used ecthyma is the term for a rash similar to impetigo, but the infection penetrates the skin more deeply. (Its therapy is similar to impetigo.)

Causes :

Impetigo is a bacterial infection. Your skin surface and the inside of your nose are normally home to large numbers of “friendly” or commensal bacteria that help protect you from disease-causing bacteria such as Staphylococcus aureus and Streptococcus pyogenes.

Your commensal bacteria work to keep down the population of pathogenic bacteria by producing substances that are toxic to the pathogens, depriving them of nutrients, among other measures.

But strains of these staph or strep bacteria can take advantage of a break in the skin from a cut, scratch, insect bite, or rash to invade and colonize, causing impetigo.

The bacteria can also colonize and cause an infection on normal skin (12). It’s not known exactly why this happens.

Within about 10 days of bacteria colonization, impetigo blisters appear (12). The way it works is that the Staphylococcus aureus and Streptococcus pyogenes bacteria produce toxins that break apart your top skin layers, causing blisters to form.

In many cases, the bacteria are already on site, waiting for an opportunity to colonize:

Staphylococcus aureus and Streptococcus pyogenes bacteria are normally carried in the nose by between 20 and 50 percent of the general population.

Further, about 10 to 20 percent of healthy people have Staphylococcus aureus bacteria in their perineum (the area between the genitals and the anus).

Different Types Of Impetigo

There are three types of impetigo distinguished by the bacteria that cause them and the sores they form.

Nonbullous, also called impetigo contagiosa, is mainly caused by Staphylococcus aureus. It’s the most common form of impetigo, an estimated 70 percent of cases.

Nonbullous impetigo can also be caused by Streptococcus pyogenes or by a combination of both staph and strep. A small number of cases, 5 to 10 percent, are caused by strep bacteria alone.

It usually starts with reddish spots that develop into small red blisters around the mouth and nose. The blisters range in size from 1 to 2 centimeters in diameter (.39 to .78 inch). The clusters of blisters may spread to other skin areas.

After a few days, the blisters burst and develop a brownish-yellow crust. The surrounding skin can look red and raw.

Nonbullous impetigo is itchy, but not painful. When the crusts heal, there are reddish spots that fade and don’t leave scars.

Nonbullous impetigo rarely occurs in children under 2.

Bullous impetigo is caused by Staphylococcus aureus.

It usually forms larger blisters or bullae filled with a clear fluid that becomes darker and cloudy. The blisters can be up to 2 centimeters in diameter (about .78 inch).

Typically, the blisters begin on unbroken skin and aren’t surrounded by reddish areas. The blisters become limp and then burst open. Then a yellowish crust forms over the sore.

Bullous impetigo is most common in newborns, especially in the diaper area or neck folds. For other ages, the blisters appear most often on the trunk and arms and legs.

The blisters usually leave no scars when they have healed.

Ecthyma is caused by Streptococcus pyogenes, Staphylococcus aureus, or both.

The infection forms small, pus-filled sores with a thicker crust. But ecthyma goes deeper into the skin than the other forms of impetigo, and it can be more severe. Ecthyma sometimes may be accompanied by swollen glands.

Ecthyma blisters can be painful and can develop into larger, deeper sores, between 0.5 and 3 centimeters in diameter (0.3 to 1.2 inches). These sores progress to have a thick crust surrounded by reddish-purple skin.

Most often ecthyma appears on your buttocks, thighs, legs, ankles, and feet. Sometimes untreated nonbullous or bullous impetigo can develop into ecthyma.

The ecthyma lesions heal slowly and may leave scars after they heal.

How does impetigo spread?

Impetigo is highly contagious. It spreads on direct contact with a skin sore or with anything that may have touched an open sore.

Though uncommon, impetigo can also spread by contact with bedding, underwear and clothes, towels and washcloths, toys, sports equipment, and anything else that came in contact with an open sore.

Risk Factor & Diagnosing

Children in day care or play groups are most at risk for impetigo. Others at risk include those with skin ailments or compromised immune systems.

Adults and children are more at risk if they:

Live in a warm, humid climate

Have diabetes

Are undergoing dialysis

Have a compromised immune system, such as from HIV

Have skin ailments such as eczema, dermatitis, or psoriasis

Have sunburn or other burns

Have itchy infections such as lice, scabies, herpes simplex, or chickenpox

Have insect bites or poison ivy

Participate in contact sports

When should you see a doctor(Diagnosing)?

It’s a good idea to see your doctor if you suspect impetigo. Antibiotic treatment for impetigo speeds up healing and can stop the spread of infection for you (or your child) and others.

With treatment, impetigo usually heals in 7 to 10 days. If you have an underlying infection or skin disease, treatment may take longer to heal.

It’s likely that your doctor can diagnose impetigo by its appearance. But in a severe case, the doctor may want to culture the bacteria.

Treatment of impetigo

Treatment for impetigo depends on how widespread or severe the blisters are

Treatment of impetigo By Antibiotics:

The Infectious Diseases Society of America recommends treatment with topical antibiotics for 5 to 7 days.
The specific topical antibiotics recommended are mupirocin and fusidic acid. A 2003 meta-analysis of 16 studies found no significant difference between these two topical antibiotics.
If your impetigo is severe or widespread, oral antibiotics are recommended. These work more quickly than topical antibiotics. However some studies show no significant difference in cure rates between topical and oral antibiotics.
The recommended oral antibiotics include anti-staphylococcal penicillins, amoxicillin/clavulanate (Augmentin), cephalosporins, and macrolides. Erythromycin was found to be less effective.
Note that oral antibiotics can have more side-effects than topical antibiotics, such as nausea.
Also, there is some evidence of antibiotic resistant staph in impetigo treatment.

Home treatments of impetigo:

You can aid the healing and the appearance of impetigo with home treatments, cleaning and soaking and bleach baths.
Cleaning and soaking the sores is recommended, three to four times a day. Make sure to wash your hands thoroughly after treating the impetigo sores.
Gently clean the sores with warm water and soap and then remove the crusts from nonbullous impetigo. Removing the crusts exposes the bacteria underneath. You can also soak the affected area in warm soapy water before removing the crusts.
Cleaning or soaking and crust removal should be done regularly until the sores heal. Dry the area and apply antibiotic ointment. Then cover the sores lightly with gauze.
For a minor outbreak, you can use an over-the-counter antibiotic ointment. Apply it three times a day, after cleaning the area. Then cover the sore with a bandage or gauze.
Another home treatment is a 15-minute bleach bath with a very dilute solution of household bleach (2.2 percent). This reduces the bacterial level on the skin, but needs to be done regularly.

How can you prevent impetigo and its spread?

Regular bathing and frequent handwashing can cut down on skin bacteria.
Cover any skin wounds or insect bites to protect the area.
Keep nails clipped and clean.
Don’t touch or scratch open sores. This will spread the infection.
Wash everything that comes in contact with the impetigo sores in hot water and some laundry bleach.
Change bed linens, towels, and clothing every day, until the sores are no longer contagious.
Clean and disinfect surfaces, equipment, and toys that may have come in contact with impetigo.
Don’t share any personal items with someone who has impetigo.
Good hygiene is key in preventing the spread of impetigo. This includes cleaning everything that comes in contact with lesions.

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