Impetigo: focus

Impetigo is a highly contagious skin infection that mostly affects children. It causes the formation of red, itchy blisters on the face, hands, limbs, and genital areas.
If the patient scratches the area, the serum-filled blisters will burst and will soon be replaced by yellow-brown scabs.

Impetigo: what is it?

Impetigo is a highly contagious superficial bacterial skin infection that mainly affects pre-school and school-age children. In some cases, impetigo can be passed from a child to an adult, usually a close family member; the skin symptoms are the same: areas of reddened skin where a discharge forms, leading to the development of typical honey-coloured scabs.

Impetigo is classified into two main clinical forms:

• Non-bullous impetigo (or crusted impetigo): this is the most common form and initially presents as red patches that develop into blisters filled with clear fluid or pus. These blisters burst quickly, leaving behind honey-coloured scabs that stick to the skin. The lesions are mainly found around the mouth, nose and hands.
• Bullous impetigo: this less common form is characterised by the presence of larger blisters (flaccid blisters), filled with a yellowish fluid, which do not burst immediately. It often affects newborns and very young children, and can also affect the trunk, genital area and skin folds. Once they have burst, scabs form in this case too, but they are larger in size.

Both forms can cause itching, a burning sensation and a general feeling of discomfort.

Impetigo is particularly common during the summer months, when heat and humidity encourage the growth of bacteria.

What causes impetigo and how is it caught?

The Staphylococcus aureus and Streptococcus pyogenes bacteria cause impetigo. These bacteria are easily transmitted in shared living environments. For example, children in kindergarten or school are often in direct contact with dirty surfaces such as the floor, and then often touch each other during play which causes the transfer of the bacteria to others, thus causing the infection.

Symptoms

Symptoms of impetigo include:

• Red, serum-filled blisters
• Itching
• Inflammation of the skin around the nose, mouth and navel

As a result of itching and scratching, the blisters burst, exposing the skin to other bacterial infections that are potentially more dangerous than impetigo.

In some cases, untreated impetigo can develop into more serious conditions, such as Group A beta-haemolytic streptococcal infection (GABHS), which can lead to kidney complications. This is a rare occurrence, in which the child urinates infrequently, has a headache and experiences fluid retention in the legs and face, which tend to swell.

Diagnosis

A dermatological examination is sufficient to diagnose impetigo, during which the typical lesions associated with the condition can easily be identified on the child’s face or other parts of the body.
Blood tests are rarely necessary, though they may be useful if there is a secondary infection (a bacterial superinfection).

Care and Treatment of Impetigo

Treatment for impetigo depends on how promptly it is diagnosed and the severity of the condition.

• In the early or localised stages, the infection can be treated effectively by applying Dermasana Aluminium Chloride to the lesions three times a day until they have completely dried out and the scabs have fallen off.

• The use of creams, including antibiotic creams, is not recommended: cream-based products tend to moisturise the skin, whereas the main aim of the treatment is to dry out the lesions in order to prevent the spread of bacteria.

• Washing or wetting the affected areas is also strongly discouraged. Keeping the skin dry helps to preserve the scabs, preventing them from softening and creating an environment that is unfavourable to bacterial growth.

• If it is necessary to clean the lesions, a Potassium Permanganate solution may be used for so-called ‘dry washing’, as explained in the article: Potassium permanganate: a helping hand in dermatology

• In more extensive, weeping or recurrent cases, oral antibiotic treatment should be administered, whilst continuing to apply Dermasana to the lesions.

Finally, in community settings (nurseries, schools, family environments), it is essential to treat all affected individuals at the same time, in order to prevent reinfection and interruptions to the course of treatment.

Is impetigo contagious?

Yes, impetigo is highly contagious, particularly among pre-school and school-age children. It is spread through direct contact with infected skin lesions or indirectly via contaminated objects such as towels, toys, surfaces or clothing. The risk of infection is particularly high in communal settings such as schools, nurseries, gyms and swimming pools, where children share spaces and tend to touch one another frequently.

Generally, the ability to transmit the infection is significantly reduced 24–48 hours after the start of effective treatment, whether topical or systemic.

Preventing impetigo: advice from dermatologists

Preventing impetigo means stopping the infection from spreading and reducing the risk of recurrence, particularly in community settings frequented by children. Here are the key steps to follow:

• Keeping your child at home during the contagious period
  It is important to keep your child at home during the first few days of treatment, avoiding contact with other children. They should only return to school or nursery when the doctor considers it appropriate, usually 48 hours after treatment begins.

• Avoid touching or scratching the lesions
  Itching can lead to scratching, which can cause the blisters to burst, allowing the infection to spread to other areas of the skin and increasing the risk of passing it on to others.

• Avoid sharing personal items
  Towels, bed linen, clothes, brushes and toys should be kept to yourself to prevent indirect contamination.

• Can I go to the beach if I have impetigo?
  No, during the active phase of the infection, it is not advisable to go to the beach or the swimming pool, both because of the risk of infecting others and because sand, sun and salt water can further irritate the skin and slow down the healing process.

If you suspect impetigo, it is essential to consult your paediatrician or dermatologist. Early diagnosis and targeted treatment are vital to prevent complications and limit the spread of the infection.