Impetigo

Definition

Impetigo is a contagious bacterial infection of the skin. It primarily afflicts children and the elderly. Ecthyma is a more severe form of impetigo with sores affecting a deeper layer of the skin. It often leaves scarring and discoloration of the skin.

Description

The first sign of impetigo is a clear, fluid-filled bump, called a vesicle, which appears on the skin. The vesicle soon dries out and develops a scab-like, honey-colored crust, which breaks open and leaks fluid. These vesicles usually appear grouped closely together, and they may spread out and cover a large area of the skin. Impetigo often affects the area around the nose and mouth; however, it can spread to anywhere on the skin, but especially the arms and legs, as well as the diaper areas of infants. The condition called ecthyma is a form of impetigo in which the sores that develop are larger, filled with pus, and covered with brownish-black scabs that may lead to scarring. Impetigo infections most commonly occur during warmer weather.

Causes & symptoms

Impetigo is most frequently caused by the bacteria Staphylococcus aureus, also known as "staph," and less frequently, by group A beta-hemolytic streptococci, also known as "strep." These bacteria are highly contagious. Impetigo can quickly spread from one part of the body to another through scratching. It can also be spread to other people if they touch the infected sores or if they have contact with the soiled clothing, diapers, bed sheets, or toys of an infected person. Such factors as heat, humidity, crowded conditions, and poor hygiene increase the chance that impetigo will spread rapidly among large groups.

Impetigo tends to develop in areas of the skin that have already been damaged through some other means such as injury, insect bite, sunburn, diaper rash , chicken pox, or herpes, especially oral herpes. The sores tend to be very itchy, and scratching may lead to the spread of the disease. Keeping the hands washed with antibacterial soap and fingernails well trimmed are good precautions for limiting further infection.

Diagnosis

Observation of the appearance, location and pattern of sores is the usual method of diagnosis. Fluid from the vesicles can be cultured and examined to identify the causative bacteria.

Treatment

Echinacea tincture can be applied directly to the skin. The homeopathic remedy Antimonium tartaricum can be used when impetigo affects the face.

Bag Balm, an anti-bacterial salve, can be applied to sores to relieve pain and heal the skin.

A tincture of the pansy flower, Viola tricolor, can be taken internally twice daily for a week to speed healing.

Burdock root oil can be directly applied to the skin to help it heal.

Topical washes with goldenseal, grapefruit seed extract (which may sting), or tea tree oil are also recommended.

Allopathic treatment

Uncomplicated impetigo is usually treated with a topical antibiotic cream such as mupirocin (Bactroban). Oral antibiotics are also commonly prescribed. Patients are advised to wash the affected areas with an antibacterial soap and water several times per day, and to otherwise keep the skin dry. Scratching is discouraged, and the suggestion is that nails be cut or that mittens be worn—especiallly with young children. Ecthyma is treated in the same manner, but at times may require surgical debridement, or removal of the affected area.

Expected results

The vast majority of those with impetigo recover quickly, completely, and uneventfully. However, there is a chance of developing a serious disease, or sequela, especially if the infection is left untreated. Local spread of the infection can cause osteomyelitis, septic arthritis, cellulitis, or lymphangitis. If large quantities of the bacteria begin to circulate in the bloodstream, there is also a danger of developing a systemic infection such as glomerulonephritis or pneumonia .

Prevention

Prevention of impetigo involves good hygiene. In order to avoid spreading the infection from one person to another, those with impetigo should be isolated until all sores are healed, and their used linen, clothing, and toys should be kept out of contact with others.

Resources

BOOKS

Foley, Denise, et al. The Doctors Book of Home Remedies for Children: From Allergies and Animal Bites to Toothache and TV Addiction, Hundreds of Doctor-Proven Techniques and Tips to Care for Your Kid. Emmaus, PA: Rodale Press, 1999.

Shaw, Michael, ed., et al. Everything You Need to Know About Diseases. Springhouse, PA: Springhouse Corporation, 1996.

Weed, Susun. Healing Wise. New York: Ash Tree Publishing, 1989

OTHER

The Nemours Foundation. http://kidshealth.org/parent/general/infections/impetigo.html.

Patience Paradox

Impetigo

Definition

Impetigo refers to a very localized bacterial infection of the skin. There are two types, bullous and epidemic.

Description

Impetigo is a skin infection that tends primarily to afflict children. Impetigo caused by the bacterium Staphylococcus aureus (also known as staph) affects children of all ages. Impetigo caused by the bacteria called group A streptococci (also known as strep) are most common in children ages two to five.

The bacteria that cause impetigo are very contagious. They can be spread by a child from one part of his or her body to another by scratching or contact with a towel, clothing, or stuffed animal. These same methods can pass the bacteria on from one person to another.

Impetigo tends to develop in areas of the skin that have already been damaged through some other mechanism (a cut or scrape, burn, insect bite, or vesicle from chickenpox ).

Demographics

About 10 percent of all skin problems in children are ultimately diagnosed as impetigo.

Causes and symptoms

The first sign of bullous impetigo is a large bump on the skin with a clear, fluid-filled top (a vesicle). The bump develops a scab-like, honey-colored crust. There is usually no redness or pain , although the area may be quite itchy. Ultimately, the skin in this area will become dry and flake away. Bullous impetigo is usually caused by staph bacteria.

Epidemic impetigo can be caused by staph or strep bacteria and (as the name implies) is very easily passed among children. Certain factors, such as heat and humidity, crowded conditions, and poor hygiene increase the chance that this type of impetigo will spread rapidly among large groups of children. This type of impetigo involves the formation of a small vesicle surrounded by a circle of reddened skin. The vesicles appear first on the face and legs. When a child has several of these vesicles close together, they may spread to one another. The skin surface may become eaten away (ulcerated), leaving irritated pits. When there are many of these deep, pitting ulcers, with pus in the center and brownish-black scabs, the condition is called ecthyma. If left untreated, the type of bacteria causing this type of impetigo has the potential to cause a serious kidney disease (glomerulonephritis). Even when impetigo is initially caused by strep bacteria, the vesicles are frequently secondarily infected with staph bacteria.

Impetigo is usually an uncomplicated skin condition. Left untreated, however, it may develop into a serious disease, including osteomyelitis (bone infection), septic arthritis (joint infection), or pneumonia . If large quantities of bacteria are present and begin circulating in the bloodstream, the child is in danger of developing an overwhelming systemic infection known as sepsis.

Diagnosis

Characteristic appearance of the skin is the usual method of diagnosis, although fluid from the vesicles can be cultured and then examined in an attempt to identify the causative bacteria.

Treatment

Uncomplicated impetigo is usually treated with a topical antibiotic cream called mupirocin. In more serious, widespread cases of impetigo, or when the child has a fever or swollen glands, antibiotics may be given by mouth or even through a needle placed in a vein (intravenously).

Prognosis

Prognosis for a child with impetigo is excellent. The vast majority of children recover quickly, completely, and uneventfully.

Prevention

Prevention involves good hygiene. Hand washing; never sharing towels, clothing, or stuffed animals; and keeping fingernails well-trimmed are easy precautions to take to avoid spreading the infection from one person to another.

KEY TERMS

Systemic —Relating to an entire body system or the body in general.

Ulcer —A site of damage to the skin or mucous membrane that is characterized by the formation of pus, death of tissue, and is frequently accompanied by an inflammatory reaction.

Vesicle —A bump on the skin filled with fluid.

Resources

BOOKS

"Cutaneous Bacterial Infections." In Nelson Textbook of Pediatrics. Edited by Richard E. Behrman et al. Philadelphia: Saunders Company, 2004.

Darmstadt, Gary L. "Cellulitis and Superficial Skin Infections." In Principles and Practice of Pediatric Infectious Diseases, 2nd ed. Edited by Sarah S. Long et al. St. Louis, MO: Elsevier, 2003.

PERIODICALS

Sanfilippo, A. M. "Common bacterial skin infections." American Family Physician 66 (July 2002): 119–24.

Stulberg, D. L. "Common pediatric and adolescent skin conditions." American Family Physician 16 (October 2003): 269–83.

Wolfrey, J. "Pediatric exanthems." Clinical Family Practice 5 (September 2003): 55–7.

Rosalyn Carson-DeWitt, MD

Impetigo

Definition

Impetigo refers to a very localized bacterial infection of the skin. There are two types, bullous and epidemic.

Description

Impetigo is a skin infection that tends primarily to afflict children. Impetigo caused by the bacterium Staphylococcus aureus (also known as staph) affects children of all ages. Impetigo caused by the bacteria called group A streptococci (also know as strep) are most common in children ages two to five.

The bacteria that cause impetigo are very contagious. They can be spread by a child from one part of his or her body to another by scratching, or contact with a towel, clothing, or stuffed animal. These same methods can pass the bacteria on from one person to another.

Impetigo tends to develop in areas of the skin that have already been damaged through some other mechanism (a cut or scrape, burn, insect bite, or vesicle from chickenpox ).

Causes and symptoms

The first sign of bullous impetigo is a large bump on the skin with a clear, fluid-filled top (called a vesicle). The bump develops a scab-like, honey-colored crust. There is usually no redness or pain, although the area may be quite itchy. Ultimately, the skin in this area will become dry and flake away. Bullous impetigo is usually caused by staph bacteria.

Epidemic impetigo can be caused by staph or strep bacteria, and (as the name implies) is very easily passed among children. Certain factors, such as heat and humidity, crowded conditions, and poor hygiene increase the chance that this type of impetigo will spread rapidly among large groups of children. This type of impetigo involves the formation of a small vesicle surrounded by a circle of reddened skin. The vesicles appear first on the face and legs. When a child has several of these vesicles close together, they may spread to one another. The skin surface may become eaten away (ulcerated), leaving irritated pits. When there are many of these deep, pitting ulcers, with pus in the center and brownish-black scabs, the condition is called ecthyma. If left untreated, the type of bacteria causing this type of impetigo has the potential to cause a serious kidney disease called glomerulonephritis. Even when impetigo is initially caused by strep bacteria, the vesicles are frequently secondarily infected with staph bacteria.

Impetigo is usually an uncomplicated skin condition. Left untreated, however, it may develop into a serious disease, including osteomyelitis (bone infection), septic arthritis (joint infection), or pneumonia. If large quantities of bacteria are present and begin circulating in the bloodstream, the child is in danger of developing an overwhelming systemic infection known as sepsis.

Diagnosis

Characteristic appearance of the skin is the usual method of diagnosis, although fluid from the vesicles can be cultured and then examined in an attempt to identify the causative bacteria.

Treatment

Uncomplicated impetigo is usually treated with a topical antibiotic cream called mupirocin. In more serious, widespread cases of impetigo, or when the child has a fever or swollen glands, antibiotics may be given by mouth or even through a needle placed in a vein (intravenously).

Prognosis

Prognosis for a child with impetigo is excellent. The vast majority of children recover quickly, completely, and uneventfully.

Prevention

Prevention involves good hygiene. Handwashing; never sharing towels, clothing, or stuffed animals; and keeping fingernails well-trimmed are easy precautions to take to avoid spreading the infection from one person to another.

Resources

PERIODICALS

"Bullous Impetigo." Archives of Pediatrics and Adolescent Medicine 151, no. 11 (November 1997): 1168+.

KEY TERMS

Systemic— Involving the whole body; the opposite of localized.

Ulcer— An irritated pit in the surface of a tissue.

Vesicle— A bump on the skin filled with fluid.

impetigo , contagious skin infection affecting mainly infants and children. The causative organisms are either hemolytic streptococci or staphylococci . The eruption consists of small red spots or blisters that rupture, discharge, and become encrusted. The infection is easily spread over the skin by fingernails because of its symptomatic itching; it can also be spread by contaminated linen, clothing, or other objects. Effective treatment with antibiotic ointments usually relieves the infection within 10 days. Systemic treatment with antibiotics is sometimes necessary to prevent the nephritis that occasionally develops.

impetigo (imp-i-ty-goh) n. a superficial bacterial infection of the skin, which usually responds to treatment with antibiotics. bullous i. impetigo caused by Staphylococcus aureus. It is characterized by blisters, is less contagious than the nonbullous form, and occurs at any age. nonbullous i. impetigo caused by Staphylococcus aureus, Streptococcus species, or both organisms; it mainly affects young children and is highly contagious, with yellowish-brown crusting.

impetigo Contagious skin condition caused by streptococcal or staphylococcal infection. It causes multiple, spreading lesions with yellowish-brown crusts.

impetigo XVI. — L., f. impetere assail, f. IM-1 + petere seek.