Impetigo

Impetigo is a bacterial infection of the surface of the skin.

Impetigo is usually due to a bacteria called Staphylococcus aureus. These germs pass from person to person by skin-to-skin contact or, less often, through bedding, clothing, and towels. Impetigo can spread rapidly through families and school classes. 

However, it can also spontaneously appear with no link to where it came from. The bacteria that cause impetigo can invade normal skin, but more often take advantage of skin that is already damaged by cuts or grazes, insect bites, head lice, scabies, cold sores, or eczema.

People with diabetes or low immunity are more susceptible to getting impetigo. Impetigo is more common in warm, humid weather.

Impetigo can make the skin red, sore, and itchy. There may be swollen glands. It is unusual to have a fever or feel very unwell.

Impetigo can appear anywhere but is most common on exposed areas of skin such as the face (around the nose and mouth) and the hands.

It starts as a rash of small, pus-filled blisters. These tend to break easily to leave round oozing patches covered with yellow or brownish crusts. 

The patches are small at first (e.g., half a centimeter or so across), but slowly get more prominent. Bacteria are easily spread, and new lesions can develop at other sites away from the initial infection.

Impetigo may also present with sore, intact blisters. This condition is known as bullous impetigo and is less common.

As the patches clear up, their crusts fall off, and the areas heal without leaving scars, although there may be temporary redness or altered pigmentation.

Your doctor or nurse will make the diagnosis based on how the rash looks and check to see if it has come up on top of another skin condition, such as scabies.

If you are getting recurrent episodes of impetigo, your doctor may take a swab from your nose to see if bacteria are present there, causing the re-infected outbreaks.

Antibiotic creams, such as mupirocin or fusidic acid, will usually be prescribed. Retapamulin is a newer antibiotic cream that is occasionally used. Use of oral antibiotics, if required.

• Avoid touching patches of impetigo and stop other people from touching them too. • Hygiene is important – always wash your hands after accidentally touching the area (and ask other people to do the same).
• Wash your hands before and after putting the antibiotic cream or ointment on the impetigo. • Don’t share towels, flannels, etc. until the infection has cleared. Always use a clean cloth each time to dry the affected area. 
• For preventing the spread of bacteria, the patient’s towels, pillowcases, and sheets should be changed and washed on the hottest available setting (at least 60 degrees) with the addition of laundry bleach. Clothing and bedding should be cleaned and changed daily during the first few days of treatment. Children with impetigo should be kept off school or nursery until affected areas have healed or 48 hours after starting antibiotic treatment.
• It is fine to continue with your regular bathing and skincare routine. However, be careful to avoid contaminating creams by touching the affected skin and then putting your finger back into the pot.