Impetigo is a skin infection typically caused by one of two bacteria: group A streptococcus (the same bacteria that causes strep throat) or staphylococcus aureus. These fairly common bacteria are found on the skin of healthy people. When the skin is broken—like with a cut or a scratch—they can enter the open wound and cause impetigo. Someone who becomes infected develops blisters that usually burst, ooze fluid and then harden into a honey-colored crust.
Impetigo can affect skin anywhere on the body but often attacks the area around the nose and mouth. It's more likely to show up on skin that's already irritated or raw from eczema, poison ivy or a skin allergy to soap or makeup. Infected bug bites are also a common cause of impetigo, especially during the summertime. Touching the infected skin and then touching another part of the body can spread the infection to that spot. It can also be spread to someone else if another person touches the infected area. Because kids in preschool and elementary school have lots of close contact with other kids, impetigo occurs most commonly in them, but most anyone can get it.
General Treatments for Impetigo
Recommendations are as follows:
- Oral antibiotics: Oral antibiotics that are effective for treatment of impetigo are antistaphylococcal penicillins, amoxicillin/clavulanate, cephalosporins, and macrolides. Erythromycin is less effective. For patients with more extensive impetigo or disease associated with systemic symptoms, oral antibiotics should be considered.
- Topical antibiotics: For impetigo involving limited body surface area, topical antibiotics such as mupirocin and fusidic acid (not available in the United States) are the preferred first-line therapy.
- Antibiotics to avoid: Oral penicillin V, amoxicillin, topical bacitracin and neomycin are not recommended for the treatment of impetigo.
- Topical disinfectants: Topical disinfectants such as hydrogen peroxide should not be used in the treatment of impetigo.
Specific Treatments for Impetigo
Despite the lack of standard treatment of impetigo, many options are available. The topical antibiotics mupirocin and fusidic acid are effective and may be superior to oral antibiotics, but the latter should be considered for patients with extensive disease. Topical disinfectants are all-in-all not helpful in treating impetigo.
- Antibiotics: Impetigo usually is treated with antibiotics, either in the form of pills or an injection. A topical skin cream such as mupirocin (Bactroban) also may be prescribed. The area around the blisters should be washed with soap and water, and the scabs should be washed away with water and an antiseptic solution such as chlorhexidine (Peridex).Afterwards, the area should be dried. Washing away the scabs allows topical medications to reach the infection more effectively. Covering the area with gauze and tape or a loose plastic bandage can help reduce the risk of spreading the infection to other parts of the body.
- Warm compress soaked in vinegar or rubbing alcohol: To help get rid of a minor impetigo due to staph infection, you might want to try a warm compress soaked in vinegar or rubbing alcohol. Vinegar has been shown to have plenty of antimicrobial power, so much so that conscientious janitors are now cleaning public restrooms with it.
On that note, if you really want to make sure those staph bacteria are dead, nothing beats good old rubbing alcohol. That's why hospitals have those cans of alcohol-based hand cleaner just laying around the place—it's almost 100% effective at killing bacteria.
- Treatment through how impetigo looks: Doctors usually diagnose impetigo based on how it looks and treat the infection with antibiotics. Your doctor probably will prescribe an antibiotic ointment. If the impetigo has spread to a lot of places, or if the ointment isn't working, you may need to take an antibiotic pill. It's important to finish all of the medicine prescribed even if the spots clear up quickly.Oral antibiotics that are given for 7 to 10 days will generally clear up impetigo. These antibiotics include derivatives of penicillin, erythromycin and cephalexin. A prescription-strength topical antibiotic such as mupirocin (Bactroban) is also very safe and effective. Its use often makes oral treatment unnecessary. Over-the-counter topical antibiotics like bacitracin or Neosporin (which contains bacitracin) don't seem to be much more effective than applying petroleum jelly or nothing at all. When they do seem to work, it's often because the condition was not infected to begin with.
- Quarantine: Because impetigo can spread from person to person through contact with the infected area, someone who has it should stay home from school while the infection is still contagious. Impetigo usually is no longer contagious after about 24 to 48 hours of treatment. After 3 days of treatment it should start to heal and scab over. If your skin doesn't begin to heal after this time, or if you develop a fever, call your doctor again. You should also let your doctor know right away if skin around the impetigo becomes red, warm, swollen or tender.
- Hygiene and general washing: In addition to taking or applying your medicine exactly as your doctor directed, you can gently wash the infected areas twice a day with an unscented soap and water, using a piece of clean gauze. If a spot is crusted, soak it in warm, soapy water for a while to remove built-up layers of the crust. You don't need to get rid of all of the crust, but it's important to keep the area clean.
Indeed, the best way to prevent impetigo is to follow good hygiene practices. Take a bath or shower regularly and use soap to keep your skin clean. Watch for skin that is injured, irritated, or raw—including cuts, scrapes, bug bites, areas of eczema, and rashes—and keep these areas clean and covered.
- Bactericidal ointment: Many General Practitioners choose to treat impetigo with bactericidal ointment, such as fusidic acid or mupirocin, but in more severe cases, oral antibiotics such as flucloxacillin or erythromycin are necessary. It's important to dissolve the scabs with ointment because the bacteria that cause the disease live underneath them.
- Calendula cream: Calendula cream is a naturally occurring antibiotic and antifungal cream derived from the Marigold plant (Calendula officinalis). It can be used to fight mild cases of impetigo and is an excellent substitute for commercial antibiotic creams if, for some reason, you're not into pharmaceutical medicines.
- Burdock: Burdock root comes in many forms: pills, powders, tinctures, fluid extracts and teas. For treatment of impetigo, 2-8 mL of burdock root tincture should be applied to a compress and wrapped around the infected area at least 3 times a day.
- Spica Prunellae Extract: Spica Prunellae Extract (Self-Heal) is an herb that is showing great potential in studies and research, showing that it has broad antimicrobial activity. In other words, it's been discovered that Self-Heal is an aptly named, naturally occurring antibiotic that's great for impetigo.
- Gauze and tape: To avoid spreading impetigo to other parts of the body, cover the infected areas with gauze and tape or a loose plastic bandage. It's also a good idea to keep your fingernails short until the infection clears up. Even though impetigo may itch, try not to scratch because scratching can spread the infection or tear the skin and make it worse. Scratching repeatedly can lead to scarring of the skin. If the itching continues, ask your mom or dad about taking an anti-itching medication like diphenhydramine. This could get you over the hump and prevent further scratching.
- Preventive measure to stop the spread of impetigo: If someone in a family has impetigo, that person should cover the sores to prevent the infection from spreading to others in the house. The person with the infection should not share clothing, towels or bed linens with anyone else. When they get dirty, wash these items separately in very hot water. Using paper towels instead of cloth towels can also help keep the infection from spreading to other people in the house. Sharing makeup is not a good idea at any time but more risky if you or your friend have impetigo.
Symptoms of Impetigo
Tiny blisters are the first symptom of impetigo caused by group A streptococcus. When the blisters burst, the skin underneath them becomes moist, red, and may ooze fluid. Next, a tan or yellow-brown crust covers the wet areas, making it look like they've been coated with honey or brown sugar. A staphylococcus infection may cause larger blisters filled with fluid that starts out clear but then becomes cloudy. These blisters usually remain whole without bursting longer than the blisters from streptococcus impetigo do. It can be difficult to tell if a case of impetigo is caused by strep or staph bacteria. But the treatment is similar, no matter which type of bacteria caused the infection.
Treatments ideally should be effective, inexpensive and have limited side effects. Topical antibiotics have the advantage of being applied only where needed, which minimizes systemic side effects. However, some topical antibiotics may cause skin sensitization in susceptible persons. In any case, now that you know most everything there is to know about impetigo, your skin health should be safe once again. Just remember to make use of these tips and information before it's too late.
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