Impetigo

Symptoms Of Impetigo 

• Red sores or blisters appear on the skin

• Itching

• Blisters may burst, releasing a clear or yellowish fluid (pus)

• Honey-colored crust or scab as the fluid dries

• Redness and swelling around the affected area

• Fever (in case of severe infection)

• In some cases, nearby lymph nodes may become swollen.

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Types of Impetigo

There are three main types of impetigo, each caused by different bacteria. They include:

1. Non-bullous impetigo (crusted)

• This prevalent type, responsible for 70% of cases, is primarily caused by Staphylococcus aureus or Streptococcus pyogenes bacteria.

• Typically starting around the nose and face, it may also affect the arms and legs.

2. Bullous impetigo (large blisters)

• Constituting 30% of cases, this variant results from Staphylococcus aureus bacteria producing a toxin, forming larger, clear fluid-filled blisters or bullae. 

Note: Both types typically resolve within two to three weeks without scarring, with rare complications such as post-streptococcal glomerulonephritis.

3. Ecthyma (ulcers)

• A severe form extending deeper into skin layers, caused by Staphylococcus aureus or Streptococcus pyogenes.

• The presence of painful, ulcerative sores that penetrate deeper skin layers, leading to scarring upon healing.

Causes Of Impetigo

• Impetigo arises when bacteria, specifically group A Streptococcus and Staphylococcus aureus, enter the body through skin breaks like cuts or scratches. 

• Subsequently, these bacteria multiply, causing an infection in the affected area.

• Characteristic symptoms, such as red sores, blisters, and skin lesions, emerge approximately 10 days after exposure to group A strep bacteria. 

• The infection, highly contagious, spreads through direct contact or touching contaminated items. 

There are two ways an initial infection can occur:

1. Primary impetigo: It is when the bacteria invades the skin through a cut, insect bite or other injury.

2. Secondary impetigo: It is where the bacteria invade the skin due to a disrupted skin barrier from another skin infection like eczema or scabies.

Impetigo is generally confused with eczema!

Impetigo is a contagious bacterial infection causing sores and crusts, while eczema is a non-infectious, chronic skin condition causing dry, itchy, and inflamed skin.

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Risk Factors For Impetigo

Several factors can increase the risk of developing impetigo. These risk factors include:

1. Age and gender

• Impetigo tends to affect children more frequently, particularly those aged 2 to 5 years old, especially in school or daycares. 

• Additionally, it is more common in males.

2. Skin injuries or conditions

• Eczema

• Dermatitis

• Psoriasis

• Scabies

• Herpes simplex

• Chickenpox

3. Environmental factors

• Insect bites and plant exposure

• Warm and humid climates

• Sharing personal items

• Overcrowded living conditions

• Poor hygiene

• Close contact with infected individuals

4. Medical conditions 

• Diabetes

• HIV or AIDS

Diagnosis Of Impetigo

Diagnosing impetigo is typically based on the following:

1. History and clinical examination

• A thorough history and physical exam are essential to spot key features of impetigo, like small blisters and honey-colored crusts.

• The doctor will ask about medical history, recent skin injuries, and potential exposure to others with impetigo for a clinical diagnosis.

2. Culture and sensitivity testing for confirmation

• In cases of recurrent, widespread, or suspected methicillin-resistant Staphylococcus aureus (MRSA) infection, a skin swab for culture and sensitivity may be recommended. 

• This helps identify the specific bacteria causing the infection and determines the most effective antibiotics for treatment.

3. Nasal swabs 

• Nasal swabs may be conducted, especially in cases of recurrent infection. 

• This test can identify staphylococcal nasal carriage, which may require specific management to prevent further episodes of impetigo.

4. Serologic testing and ASO response

• The anti-streptolysin O (ASO) response is usually mild in cases of impetigo, so testing for streptococcal antibodies isn't commonly used for diagnosis. 

• However, it may be done if post-streptococcal kidney infection is suspected following an impetigo outbreak.

5. HIV Testing in bullous Impetigo

• This is done for previously healthy adults presenting with bullous impetigo.

• HIV testing should be contemplated to rule out underlying human immunodeficiency virus (HIV) infection.

6. Skin biopsy

• In rare cases where the diagnosis is uncertain, particularly with bullous impetigo, or if the condition doesn't improve with treatment, a skin biopsy may be recommended. 

• This involves removing a small sample of the affected skin for further analysis.

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Prevention Of Impetigo

Preventing the spread of impetigo is crucial not only to protect others but also to prevent the infection from advancing to other areas of your body. Here are some preventive measures:

1. Hygiene practices

• Wash hands regularly with soap and water, especially after contact with potentially contaminated surfaces or individuals with impetigo.

• Change towels and washcloths daily, launder sheets, linens, and bath towels in hot water, and apply anti-itch cream to lesions to discourage scratching.

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3. Cleanliness

• Maintain clean skin through regular bathing to eliminate bacteria and prevent skin infections.

• Wear clean clothes, wash worn garments in hot water, and practice frequent handwashing, particularly after handshakes.

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Other preventive tips:

• Don't share personal items like towels or clothing with infected individuals.

• Keep communal areas clean, especially in schools or daycare.

• Athletes should maintain hygiene and care for wounds properly.

• Change and wash bedding and clothing regularly to prevent bacteria from spreading.

• Practice good nasal hygiene to reduce recurring impetigo.

• Treat skin conditions early to prevent bacterial infections.

Doctor To Visit

The specialists who can assist you in managing impetigo include:

• General Physicians
• Pediatricians
• Dermatologists
• Allergists
  
  

General Physicians: They can often diagnose and treat mild Impetigo. They can also refer you to another specialist if needed.

Pediatricians: A pediatrician is the ideal first point of contact for children with Impetigo. They have expertise in handling childhood skin infections.

Dermatologists: Skin specialists trained in diagnosing and treating skin conditions like impetigo. They can accurately diagnose the type of Impetigo and prescribe appropriate antibiotics or other medications.

Allergists: Allergists can be consulted to identify any potential triggers or underlying allergic factors contributing to the impetigo infection.

When to see a doctor?

While Impetigo is a common skin infection and often resolves on its own within a few weeks, seeking medical attention is always recommended under the following circumstances:

• If you experience persistent itching and dryness associated with impetigo.

• When impetigo symptoms significantly affect your daily activities, productivity, and quality of sleep.

• If over-the-counter medications fail to bring relief, and the skin infection shows signs of worsening.

• If symptoms of impetigo are accompanied by fever, indicating a potentially more severe infection.

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Treatment Of Impetigo

The treatment approach may involve both topical and, in some cases, oral antibiotics. 

Here's how impetigo is commonly treated:

1. Topical antibiotics (for localized non-bullous impetigo)

Primary treatment for mild cases involves applying antiseptic creams 2–3 times daily for 5–7 days.

• Antiseptics

  • Hydrogen peroxide

  • Povidone–iodine 

• Antibiotics

  • Fusidic acid

  • Mupirocin

  • Retapamulin

2. Oral Antibiotics

Prescribed for bullous impetigo, widespread non-bullous impetigo (more than three lesions), treatment failure with topical antibiotics, high risk of complications, or systemic illness. Common drugs include: 

• Cefuroxime

• Dicloxacillin

• Flucloxacillin

• Amoxicillin.

Note: Trimethoprim + Sulfamethoxazole or Erythromycin are used especially in cases of penicillin allergy or for MRSA infection.

3. Systemic Antibiotics

These are recommended in case of bullous impetigo or non-bullous impetigo with more than five lesions, deep tissue involvement, systemic signs, lymphadenopathy, or oral cavity lesions. Drugs include: 

• Cephalosporins, amoxicillin-clavulanate, dicloxacillin

• Penicillin (if streptococci infection is confirmed)

• Clindamycin or Doxycycline for MRSA or if cultures are MRSA-positive.

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4. Recurrence and bacterial carriage evaluation

• If impetigo recurs, evaluate for bacterial carriage.

• The nose is a common reservoir; carriers can be treated with mupirocin (Bactroban Nasal) applied in the nostrils.

Home-care For Impetigo

Home remedies can help manage your symptoms and aid in the healing process. However, they should be used in addition to antibiotic treatment, not as a replacement. Natural remedies for impetigo may include:

1. Tea Tree Oil: Tea tree oil is known for its antimicrobial properties. However, it's crucial to dilute it properly and perform a patch test before applying it on the skin, to ensure it doesn't irritate.

2. Olive oil (Jaitun ka tel): Olive oil is often used for its moisturizing properties. 

How to use it?

Applying a thin layer of olive oil to the affected skin may help keep it moisturized.

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3. Coconut oil: Coconut oil is known for its moisturizing and antimicrobial properties. 

How to use it? 

Applying a thin layer of coconut oil to the affected area may provide relief from impetigo symptoms.

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4. Turmeric (Haldi): Turmeric contains curcumin, known for its anti-inflammatory and antibacterial properties.

How to use it? 

Applying a turmeric paste to the affected area may provide relief.

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5. Aloe Vera: Aloe vera has soothing properties and may promote skin healing.

How to use it?

Apply aloe vera gel directly to the affected area.

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6. Colloidal silver: It is used as a topical agent due to its antimicrobial properties. It helps to fight infection inside and outside.

7. Apply anti-itch cream

• Apply anti-itch cream to impetigo lesions to alleviate itchiness.

• Be cautious not to scratch, as this can spread bacteria.

• Trim nails to minimize the risk of bacterial transfer.

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Impetigo care tip

Keep impetigo at bay! Wash hands thoroughly with soap and warm water for at least 20 seconds, ensuring you scrub front, back, and between fingers. Use alcohol-based hand sanitizer when water and soap aren't available.

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Complications Of Impetigo

Complications of impetigo can arise if the condition is not promptly and adequately treated. Here are potential complications:

1. Wider Spread Infection

• Cellulitis: Infection spreads to surrounding skin.

• Lymphangitis: Bacterial involvement in lymphatic vessels.

• Septicemia: Presence of bacteria in the bloodstream.

2. Staphylococcal scalded skin syndrome: A condition caused by toxins released by Staphylococcus aureus, leading to widespread skin damage.

3. Scarlet fever: A streptococcal infection, including impetigo, can sometimes lead to scarlet fever, characterized by a red rash, fever, and sore throat.

4. Post-streptococcal glomerulonephritis (PSGN): A rare kidney condition occurring 2–6 weeks post-skin infection with Streptococcus pyogenes, causing inflammation of the kidneys.

5. Rheumatic fever: Untreated streptococcal infections can increase the risk of rheumatic fever, which can affect the heart, joints, skin, and other organs.

6. Streptococcal toxic shock syndrome: Rare complication resulting in a diffuse erythematous rash, hypotension, and fever due to toxins released by Streptococcus pyogenes.

7. Postinflammatory pigmentation: Discoloration of the skin as a result of the inflammatory response.

8. Scarring: Particularly associated with a more severe form of impetigo and ecthyma, leading to deeper skin damage.

Alternative Therapies For Impetigo

While complementary and alternative therapies can offer supportive benefits, they are not a substitute for conventional medical treatment. Here are some complementary and alternative therapies that have been explored for impetigo:

1. Topical Disinfectants

• Some studies suggest non-antibiotic treatments like disinfectant soaps may help, but the evidence is weak, and they are not as effective as topical antibiotics.

• Research comparing disinfectants like hexachlorophene and hydrogen peroxide with antibiotics found topical antibiotics to be more effective in treating impetigo.

2. Retapamulin Therapy

• Retapamulin, derived from an edible mushroom, works by stopping bacterial protein synthesis and is effective against S. aureus and S. pyogenes but not MRSA.

• While retapamulin shows good clinical results for impetigo, it may not fully eliminate bacteria.

Living With Impetigo

Living with impetigo can significantly impact an individual's quality of life due to various physical, emotional, and social factors. Here are some ways in which impetigo can affect one's overall well-being and their coping strategies.

1. Physical discomfort: Impetigo sores, causing persistent itchiness and pain, resulting in discomfort, accompanied by skin irritation and heightened sensitivity.

Coping strategies

• Use prescribed treatments to manage itching and pain effectively.

• Adopt gentle skin care practices to minimize skin irritation and sensitivity.

2. Social stigma and isolation: The contagious nature of impetigo may lead to social stigma, triggering feelings of isolation among affected individuals.

Coping strategies

• Educate friends, family, and colleagues about impetigo to dispel misconceptions.

• Foster open communication to reduce feelings of stigmatization and encourage understanding.

3. Psychological impact: Coping with the visible and contagious nature of impetigo can induce emotional stress and anxiety, potentially leading to depression and affecting overall mental well-being.

Coping strategies

• Seek emotional support from loved ones or mental health professionals.

• Practice stress-reducing activities like mindfulness meditation to alleviate emotional stress and anxiety.

Tips For Caregivers

• Maintain cleanliness: Keep affected areas clean by gently washing them with mild soap and water.

• Use bandages: Cover sores with clean bandages to minimize the risk of spreading the infection.

• Prevent scratching: Trim the patient's nails and discourage them from scratching the sores.

• Practice hand hygiene: Wash your hands frequently, especially after touching the infected areas.

• Limit sharing: Avoid sharing towels, clothing, and bedding to prevent cross-contamination.

• Disinfect regularly: Clean common areas and wash clothes, bedding, and towels in hot water to eliminate germs.

• Adhere to treatment: Follow treatment instructions for antibiotics closely to ensure effective healing.