Definition

Impetigo is a highly contagious bacterial infection of the skin surface commonly seen in infants and young children. According to data from the WHO, around 111 million children in developing countries have been affected by impetigo. A person can get impetigo more than once, so if you've had impetigo once it doesn't mean you'll never get infected again.

Causes

There is bullous impetigo and non-bullous impetigo, which is more common. Toxins produced by Staphylococcus aureus bacteria cause bullous impetigo, while non-bullous impetigo is usually caused by Staphylococcus aureus, Streptococcus pyogenes, or both. The bacteria infect the skin and cause sores to form.

The bacteria can spread to other people when they come into contact with the sores or fluid discharged from the sores of people with impetigo. Transmission can also occur by touching items touched by someone with impetigo, such as clothing, bed linen, towels, and toys. Humans are the main host for Streptococcus pyogenes bacteria. No studies have shown that animals can spread this bacteria to humans.

Not everyone who gets infected with the bacteria will later develop impetigo.

Risk factor

Anyone of all age can get impetigo, but some factors can increase a person's risk of getting infected, namely:

• Impetigo is most commonly found in children ages 2 to 5 years.
• Presence of infections or wounds on the skin. People with cuts or scratches on the skin or other skin diseases, such as scabies or eczema, that result in skin cuts are more at risk of developing impetigo. Meanwhile, people who play sports such as wrestling or soccer are prone to getting scratches or cuts, making them more susceptible to impetigo.
• Close contact or densely populated environments. Close contact with others with impetigo is the most common risk factor for developing impetigo. For example, a person with impetigo often transmits the disease to people in the same household. Infectious diseases tend to spread when large groups of people are present. Crowded conditions such as schools and daycare centers may increase the risk of impetigo transmission.
• Participate in sports that involve skin contact.
• Impetigo is more common in hot and humid (summer) weather and subtropical or tropical climates. However, note that this condition can occur anywhere.
• Lack of hygiene. Not washing your hands, showering, or washing your face properly can increase your risk of developing impetigo.
• Certain medical conditions, such as diabetes or weakened immune system.

Symptoms

Non-bullous Impetigo

Non-bullous impetigo has symptoms that include reddish open sores with pruritus that may ooze clear fluid or pus within a few days. In about a week, a thick scab-like lesion called crust forms over the sores. These crusts are usually golden yellow or honey-colored.

Bullous Impetigo 

Bullous impetigo causes large blisters on the trunk. In mild forms, wound healing occurs without leaving scars. 

In general, impetigo is a mild infection and can occur anywhere on the body. However, it most commonly occurs on exposed or unprotected parts of the body, such as around the nose and mouth or on the hands and feet. It can spread from one part of the body to another by hand or clothes.

Diagnosis

Doctors generally diagnose impetigo by inspecting the sores during a physical examination. Laboratory tests are not required for diagnosis. However, suppose the sores do not go away despite being treated with antibiotics. In that case, the doctor may take a sample of the wound fluid to examine which antibiotic is best for the patient, as some types of bacteria that can cause impetigo are resistant to certain antibiotics.

Management

Impetigo can be treated with antibiotics. If there are only a few sores, an antibiotic ointment such as mupirocin can be used. This antibiotic can be used up to three times daily for five to ten days. Before applying the antibiotic, clean the wound area with warm water or compress it with a wet cloth for a few minutes. Afterward, pat gently to remove the crusts so the antibiotic can absorb properly. A non-stick bandage can cover the wound so the sores do not spread to other body areas.

If the wound is large, the doctor may prescribe oral antibiotics. Antibiotics can also reduce transmission and will help protect others from impetigo.

If your child has impetigo, cutting the child's nails to prevent scratching, which can develop sores, is a good thing to do.

Complications

Impetigo very rarely causes serious complications. Complications that may occur are as follows:

• Renal impairment (post-streptococcal glomerulonephritis) can be a complication of impetigo, although it is rare. This condition is caused when the infection triggers an immune response. It generally starts to appear one to two weeks after the skin sores have disappeared.
• The infection could spread to the surrounding tissues of the skin, lymph nodes, or bloodstream, and it can potentially be life-threatening.

Prevention

There is no vaccine to prevent impetigo, but there are some things that can be done to prevent the transmission of impetigo:

• Wound care. Good wound care is a great way to prevent bacterial skin infections, including impetigo. You can do this to treat your wounds:
• Cleaning minor wounds, such as scratches on your skin, with soap and water
• For open wounds or wounds with discharge, clean and cover them with a clean, dry bandage until they heal.
• If the wound is deep or severe, see a doctor.
• If you have open sores or an active infection, you should avoid bathing or taking hot baths, swimming, and bathing in rivers, lakes, or the sea.
• If you have impetigo, cover the sores to prevent transmission of the bacteria to others.

• Maintain hygiene. Maintaining personal hygiene, showering, and washing hair regularly with soap and clean running water are ways to prevent impetigo. The best way to avoid getting infected or transmitting group A streptococcus bacteria is to wash your hands frequently, especially after coughing or sneezing. To prevent this bacterial infection, you should:
• Cover your mouth and nose with a tissue or mask when coughing or sneezing. If no tissue is available, cover your mouth and nose with your upper arm or folded elbow, not your hand.
• Dispose of used tissues or masks in the trash.
• Wash hands frequently with soap and water for at least 20 seconds
• Use alcohol-based hand rub if soap and water are not available
• You should wash the clothes, linens, and towels of impetigo patients in hot water daily. These items should not be shared with others unless washed properly.
• If you are applying antibiotics to a child, wear gloves and wash your hands after applying the medicine.

• Treat other skin conditions, such as scabies or dermatitis, to reduce the risk of infection with bacteria that could cause impetigo.
• If impetigo occurs, you can only go to work or school if you have taken antibiotics for at least 24 hours and cover all sores in the body that are not covered by clothing.

When to see a doctor?

If you suspect your child or yourself of impetigo, you should consult a doctor.

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