What are the other Names for this Condition? (Also known as/Synonyms)

• Bullous Impetigo
• Impetigo Contagiosa
• Streptococcal Vesiculitis

What is Impetigo? (Definition/Background Information)

• Impetigo is a contagious skin infection, which causes red and itchy patches on the skin that are fluid-filled and painless
• Impetigo is caused by bacteria Staphylococcus aureus or Streptococcus pyogenes. The condition is classified into two types namely:
  • Non-Bullous Impetigo or Impetigo Contagiosa, where red sores appear around the mouth and nose
  • Bullous Impetigo, which is common among babies and children under the age of 2 years. Fluid-filled blisters appear on the trunk, legs, and arms
• It is a most common condition among children, teens, and young adults. Children living in crowded conditions and attending daycare are at a higher risk of the infection
• A diagnosis of Impetigo requires a physical exam and culture of the fluid and pus oozing from the sore, for the presence of bacteria
• Antibiotics are the mainstay of treatment for impetigo. This skin condition has a very good prognosis, because it responds to treatments really well
• However, untreated cases may result in kidney damage and infection of the deeper skin layers

Who gets Impetigo? (Age and Sex Distribution)

• Impetigo may affect any individual; although, children and young adults are most commonly affected
• It affects both male and female children equally
• Impetigo is common in hot and humid weather conditions around the world; there is no racial or ethnic predilection

What are the Risk Factors for Impetigo? (Predisposing Factors)

Even though every individual can be affected by Impetigo, following are the main risk factors associated with this bacterial infection:

• Children less than 6 years of age (because their immune system is  in the developing stage)
• Attending school, childcare, or daycare centers
• Crowded conditions and people gathering at crowded places increase the risk
• Direct contact with an infected individual
• Sharing towels, bed, and clothes of someone with the infection
• Warm humid weather increases the chances of Impetigo infection
• The presence of pre-existing chronic dermatitis (inflammation of the skin) can increase the risk
• Older adults with diabetes and those with weak immune systems are more susceptible to develop a more serious form of Impetigo called Ecthyma

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Impetigo? (Etiology)

Impetigo is caused by two types of bacteria: Staphylococcus aureus (or staph) and Streptococcus pyogenes (or strep).

• Typically, these bacteria enter the human skin through open cuts and wounds
• Both staph and strep bacteria spread easily on contact with infected individuals
• Also, the sharing of infected materials and items such as towels, bed, and clothes can help spread the condition
• The bacteria produce a toxin that damages the proteins binding the skin cells. Once this protein is damaged, it becomes easy for the bacteria to enter the skin and cause an infection
• Dermatitis is any form of skin inflammation, which makes one highly vulnerable to contracting Impetigo

What are the Signs and Symptoms of Impetigo?

The signs and symptoms of Impetigo may include:

• Red sores which quickly rupture, ooze for a few days and then form a yellowish-brown crust
• Itching
• Painless blisters, filled with fluid
• In rare and serious forms of Impetigo, painful sores that are filled with fluid or pus, may turn into ulcers
• Ecthyma is a more serious form of Impetigo that penetrates deeper into the second layer of the skin. It mostly affects individuals with poor immunity and the elderly adults

How is Impetigo Diagnosed?

The diagnosis of Impetigo may involve:

• Complete evaluation of medical history along with a thorough physical exam, including examination of the skin sores and blisters
• A culture may be performed to confirm the presence of bacteria and to rule-out other causes of infection. In this culture, a small amount of pus or fluid from one of the sores is collected and sent to the lab for testing. The test results can help confirm the presence and type of bacteria (if any)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Impetigo?

Impetigo is generally termed as an easily curable infection, but when left untreated, it may lead to some serious complications such as:

• Post-streptococcal glomerulonephritis (PSGN) - a kidney inflammation that occurs because of the antibodies formed in the body as a result of infection. These antibodies damage the glomeruli, which are small structures that filter the wastes in the kidney. An immediate treatment with medication helps in recovery, but a lack of or delayed treatment may cause  serious kidney failure
• Cellulitis: It affects the tissues under the skin and spreads to the lymph nodes and blood stream. A prompt diagnosis and early treatment is required to avoid the condition from becoming very serious to fatal
• Methicillin-resistant Staphylococcus aureus (MRSA) infection: This is a serious skin infection that is  difficult to treat. It starts with an appearance of red, swollen pimples or boils, filled with pus. MRSA can lead to pneumonia and blood infections
• Scars: The sores and blisters may sometimes leave scars on the skin
• Lightening (hypopigmentation) or darkening (hyperpigmentation) of the skin is another complication with Impetigo

How is Impetigo Treated?

Impetigo is usually treated with antibiotics, either in the form of pills or topical ointments. A comprehensive treatment for Impetigo includes healing the sores, improving skin appearance, and arresting the spread of the infection. The treatment measures may include:

• Employing hygienic measures, such as keeping the skin clean, can heal mild infections faster and without much effort
• The areas around the blisters should be gently washed with soap and running water, Moist, yellow scabs can be cleansed  with hydrogen peroxide, diluted with water
• Topical antibiotics: Topical antibiotics, such as ointments mupirocin and retapamulin, prescribed by the physician can be applied to the affected areas
• Oral antibiotics are prescribed for widespread Impetigo, Ecthyma, and Impetigo Contagiosa. The entire course of medication prescribed by the healthcare provider should be completed for effective cure and prevention of recurrence
• Covering the affected areas with gauze or loose bandaging helps in reducing the risk of further infection spread

How can Impetigo be Prevented?

Following are some of the precautionary measures for preventing Impetigo:

• Always keeping the skin clean and healthy. It is the best prevention method available
• Cuts, scrapes, insect bites, and wounds must be washed immediately and antibiotic ointment applied, to prevent further spread of the infection
• The Impetigo sores should be washed with soap and running water. The affected area should be covered lightly with gauze to prevent the spread of infection
• Wearing gloves while applying ointment on the blisters is advised. Washing the hands after applying ointment on the blisters is always recommended
• Items used by the infected individual, such as towels, clothing, bed, etc., should be washed or cleaned everyday
• Avoid sharing clothes, towels, bed, and any other item of the infected individuals
• Infected children’s nails should be cut really short so that further infection from scratching the blisters can be avoided
• Frequent washing of hands
• The infected child or adult is best advised to stay indoors, until he/she is fully recovered

What is the Prognosis of Impetigo? (Outcomes/Resolutions)

• In general, the prognosis for Impetigo is excellent with suitable treatment. Impetigo cures easily without leaving any scars or blemishes, unless the blisters are picked (scratched)
• But infants are likely to develop complications such as kidney inflammation or blood infection. They also carry a high risk of infection recurrence

Additional and Relevant Useful Information for Impetigo:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/