Understanding Impetigo: Causes, Types, Symptoms, and Prevention Tips

Impetigo is a common acute superficial bacterial skin infection characterized by pustules and honey-colored crusted erosions. It’s a condition that you might not think about often, but it's crucial to be aware of, especially if you have children or work in environments where it's prevalent. Let's dive into the details of this condition, its causes, types, clinical features, treatment, and prevention.

Impetigo is most commonly caused by a bacterial infection with Staphylococcus aureus. Non-bullous impetigo can also be caused by Group A beta-hemolytic streptococcus. A handy way to remember the causative agent is that "aureus" in Latin means gold, which corresponds to the honey-colored crusted lesions typical of impetigo.

Several factors predispose individuals to impetigo. These include atopic dermatitis, scabies, and any form of skin trauma such as chickenpox, insect bites, abrasions, or lacerations. These conditions create an entry point for the bacteria, especially when the skin is scratched or otherwise compromised.

There are three broad types of impetigo: non-bullous impetigo, bullous impetigo, and ecthyma.

Non-bullous impetigo is the most common form. In this type, staphylococci and streptococci invade a site of minor trauma, where exposed proteins allow the bacteria to adhere. It starts as a pink macule that evolves into a vesicle or pustule and then into erosions with a honey-colored crust. Untreated, it usually resolves within two to four weeks without scarring. Although many children with impetigo are generally well, some may experience lymphadenopathy, mild fever, and general malaise.

Bullous impetigo, on the other hand, is characterized by large blisters called bullae, which are usually found in areas with skin folds such as the armpit, groin, between the fingers or toes, beneath the breast, or between the buttocks. This type is also caused by Staphylococcus aureus and presents with large, fluid-filled blisters.

Ecthyma, also known as deep impetigo, starts as non-bullous impetigo but develops into a punched-out necrotic ulcer that heals slowly and can leave a scar. Ecthyma is usually due to Streptococcus pyogenes, but co-infection with Staphylococcus aureus can occur.

Diagnosing impetigo is typically done clinically. A healthcare professional will make the diagnosis based on the appearance of the skin. However, it can be confirmed with bacterial swabs sent for microscopy, culture, and sensitivity. In severe cases, blood tests may be conducted to reveal an elevated white cell count due to increased neutrophils.

Treatment of impetigo can be divided into general and specific measures. General treatment includes basic wound care like cleansing, using moist soaks to gently remove crusts, and applying antiseptic two to three times daily for five days. Specific treatment often involves oral antibiotics, especially if the symptoms are significant or severe. For example, oral flucloxacillin is commonly prescribed at 500 milligrams to a gram four times a day for seven days in adults. The choice of antibiotics will depend on the patient's allergies and local antibiotic prescribing guidelines.

Topical antibiotics like fusidic acid are usually discouraged due to the potential for developing bacterial resistance and contact allergic dermatitis.

Preventative measures are crucial in managing impetigo. Applying Naseptin cream into the nostrils can help, but this should be avoided in patients with peanut allergies. Washing daily with antibacterial soaps, cutting nails, maintaining hand hygiene, and identifying and treating the source of re-infection are all essential steps. Since impetigo is a contagious skin infection, avoiding close contact with others, especially if someone is known to have the infection, is important. Children with impetigo should stay away from school until the crusts have dried out or until 24 hours after starting oral antibiotics. Using separate towels and flannels and changing and laundering clothes and linen daily are also recommended.

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