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Impetigo symptoms and treatment

Impetigo is a contagious bacterial skin infection forming pustules and sores. The infection is also referred to as school sores, as it is most common in children.

Causes and risk factors

Impetigo is caused by the bacteria Streptococcus pyogenes or Streptococcus aureus.

streptococcus aureus

It is a highly contagious infection which is more likely to occur in pre-school children. However, adults may also be affected, especially if they play sports which involve close contacts, such as wrestling and rugby.

The infection is more likely to be transmitted through direct contact with sores or blisters. A child may catch the infection if he or she has cuts or scrapes, or some other skin tears or diseases. However, the infection may transmit even if there are no skin tears. Impetigo can also spread through contact with infected object, such as clothes or towels. Other risk factors include:

- warm and humid weather;
- having chronic skin diseases, such as dermatitis;
- having suppressed immune system or diabetes;

Impetigo symptoms

The incubation period usually lasts for 1-3 days. There are three types of impetigo depending on its clinical presentation:

- Impetigo contagiosa, or nonbullus impetigo. It is the most common type of the infection, which forms red painless and sometimes itchy sores on the child’s face, usually around the mouth and nose.
impetigo on the childs face
The sores burst soon after appearance and leave crusts formed from the pus oozing from the sores.
impetigo on the childs face
When the sores eventually heal, they normally leave no scarring.
- Bullous impetigo forms filled with fluid blisters on the trunk and extremities.
bullous impetigo
The blisters may vary in size and usually last longer than sores, caused by other types of the infection. When the blisters rupture they leave yellowish crusts. This type is most likely to occur in infants and children under 2 years of age.
- Echtyma is the most dangerous type of impetigo which affects dermis, the second layer of the skin, most often on the lower extremities. It forms painful sores, filled with fluid or pus, which develops into ulcers.
When the sores rupture they scab over with thick grayish crust. Echtyma may leave scars on the skin after healing.
Impetigo contagiosa and echtyma may also cause swollen lymph nodes.

Diagnosis and treatment

The diagnosis is made on the basis of visual examination. In some cases lesion or skin culture may be required. Other tests may be needed if the infection is too severe and has spread to other parts of the body, or if the disease does not react on treatment. Differential diagnoses include scabies, ringworm, and shingles.

Mild cases may heal within a couple of weeks without treatment, but it is better to apply medications to prevent further spread of the infection. Impetigo is treated with oral and topical antibiotics. For mild cases (when a small area is affected) mupirocin or retapamulin ointment may be prescribed. The scabs should be gently removed before applying the ointments. To make it easier to remove the scabs it is recommended to soak the affected skin area with a solution of 1 tablespoon of white vinegar and 16 ounces of water for 15-20 minutes. Wash your hands thoroughly after applying the ointment.

Severe cases often require oral antibiotics, such as dicloxacillin, erythromycin, and flucloxacillin. Apart from medications, the treatment involves proper care for prevention of further spread of the infection, which includes:

- avoiding touching or scratching of the lesions;
- regular washing of affected skin with soap;
- wearing loose clothes to prevent irritating of affected skin;
- avoiding sharing of clothes, towels, and other objects that may be infected.
The sores usually start healing within a few days after initiation of treatment. Antibiotic course usually lasts for a week. It is very important to complete the treatment course, even if the symptoms have improved.

Rare severe cases of impetigo may cause the following complications:
- scars or skin damage or discoloration;
impetigo scar
- infection may spread to other parts of the body;
- poststreptococcal glomerulonephritis, which may lead to kidney failure;
- cellulitis (inflammation of subcutaneous connective tissue);
cellulitis impetigo
- MRSA infection (Methicillin-resistant Staphylococcus aureus), which may cause serious skin and blood infections, and pneumonia.


Impetigo can be prevented by practicing proper hygiene. Wash your hands regularly and pay special attention to scratches and other skin tears. Ensure that your child follow these recommendations.

If someone in your family has impetigo, do not share any objects with the infected person and avoid touching the sores. The infected person should keep fingernails trimmed. If you take care of your child and have to contact with his skin while applying the ointment, wash your hands with antibacterial soup after each procedure. You can prevent your child from touching or scratching the infected area by covering it with gauze. You should also wash the clothes and personal objects of the infected person regularly.

An infected child may return to school 48 hours after treatment initiation.

These articles can be used for informational purposes only. To get an accurate diagnosis consult your doctor!

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