Impetigo

Impetigo is a common skin infection seen in children. It is contagious, and needs antibiotic treatment.

This post is written to give you pointers on how to identify it quickly and treat it effectively to prevent it from spreading.

What is it?

We all carry bacteria on our skin. When there are breaks in the skin barrier (e.g, minor cuts, scratches, insect bites or even rubbing of the skin) these bacteria enter and cause an infection. This is impetigo.

The two main causes are the Staphylococcus and Streptococcus species, and certain strains are associated with more extensive and severe symptoms.

How do you know?

There are a few different forms of impetigo. Symptoms include:

• Red bumps which become larger and more blister-like (filled with clear fluid OR pus), and then ooze and crust over.

  • A classic-appearing “honey-colored” crust forms over those areas within a week of the initial rash. This is a hallmark of impetigo.

  • The rash can be slightly itchy or tender

  • The blisters can be quite large and one form is called bullous impetigo.

• Impetigo can also present with deeper, more painful ulcers called ecthyma (although this is more rare)

• Rash most commonly seen on the face - around the mouth and nose, and in the diaper region.

• If there are symptoms that are more systemic such as fever (which is not common) it may be an indication that the infection is more serious.

• Some kids have swollen lymph nodes as well.

Transmission & Incubation:

Impetigo is contagious. It spreads easily in conditions such as:

• close skin-to-skin contact, for example crowded conditions, contact sports (wresting, football), or in daycares.

• poor hygiene

• warm/humid weather

• frequent skin trauma.

  • eg kids with eczema who are frequently scratching, or in kids with other skin infections (such as Hand/Foot/Mouth infection or Scabies).

• Kids < 5 year old who drool a lot, and have ongoing moisture/irritation around their mouth

• Children with allergies or colds who are frequently wiping their nose with tissue.

Is it serious?

In most cases, Impetigo is easily treated with antibiotics. However, in rare situations we can see worsening or deeper infections (cellulitis), ongoing skin issues, and scars.

The Pediatrician Mom Tip: VERY rarely, impetigo can cause kidney complications, which present 1-2 weeks after the initial infection (symptoms include swelling, fever, brown urine, and high blood pressure). Make sure you watch for these symptoms.

What can you do?

Impetigo needs antibiotic treatment. Depending on how extensive it is, your doctor may start with just a topical ointment or they may prescribe an oral medication.

• Gently wash the sores with mild soap and water daily

If your doctor prescribes an topical antibiotic:

• If there is a hardened or dry crust, use a wet gauze on it (or another warm soak) to soften the crust so it can be removed before applying the antibiotic ointment.

If your doctor prescribes an oral antibiotic:

• Complete the full course of medication as prescribed.

The Pediatrician Mom Tip: Children with eczema are at higher risk for Impetigo outbreaks

When to call the pediatrician

This is not a comprehensive list. In general, always err on the side of calling your pediatrician if you have any concerns about your child. There is a lot to be said for a parent’s gut instinct, and I promise: your pediatrician would rather you called!

If your child is not improving within a few days, or if they seem to be getting worse, call your pediatrician. Other concerning symptoms include:

• Severe pain or difficulty being consoled

• Lack of improvement despite antibiotic treatment

• Fever, vomiting, or other systemic symptoms

• Swelling of any part of the body, dark urine, headaches, fever or any other unusual symptoms 1-2 weeks after infection.

• Anything else tickling your spidey sense!!

FAQs

Can adults get it?

Yes.

How do I prevent spread? 

• Treat appropriately with antibiotics.

• Good hand washing with soap and water (alcohol-based sanitizers can help too).

• Disinfect frequently touched household surfaces (doorknobs, counters, etc).

• Limit sharing of intimate items.

• Keep nails short. Discourage scratching, picking, touching.

• Keep rash covered

Does my child need to stay home from school?

In general, children can return to school 24 hours after starting antibiotic treatment.

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Impetigo is an easily treatable condition if it is recognized.

My hope is that this article arms you with the tips you need to recognize and address it quickly so your kids can get back to school, playdates and fun as soon as possible!