Impetigo

summary about impetigo

Impetigo is the most common bacterial skin disease in children, especially in summer. The most common responsible germs are usually Staphylococcus aureus and group A beta-haemolytic streptococci (Streptococcus pyogenes). This infection is more found in developing countries, where the lifestyle is more precarious, especially in countries with a hot and humid climate.

In general, those most likely to develop this disease are children under 10 years of age who attend public places (schools and day care centers). This skin disease is highly contagious through direct contact with lesions or contaminated objects (clothes, hands), it is absolutely necessary for infected people to remain in isolation during the entire infection or 48 hours after starting oral antibiotic therapy. As far as adults are concerned, immunocompromised and diabetic individuals are more likely to develop the disease. The latter can develop a more serious nature such as ecthyma, a deeper lesion in the skin, which can lead to the formation of scars.🇧🇷

The symptoms of this disease are very characteristic: rashes in the form of erythema, followed by the appearance of blisters with the formation of meliceric crusts (honey-colored). At first, the general condition is good, the patient does not have a fever or has a mild form.

These symptoms are usually sufficient for the diagnosis. A bacteriological sample for identification of the causative organism is required in cases of recurrent impetigo.

Treatment of impetigo mainly boils down to cleaning the skin with soap and water, drying it and applying an antibiotic cream. When the lesions are extensive, the use of an oral antibiotic is necessary.

It is possible to use alternative treatments for impetigo, but they should be used in addition to antibiotic treatment. Tea tree essential oil mixed with lavender essential oil and sweet almond vegetable oil has been a very effective antiseptic and healing lotion. The only precaution is the known sensitivity to these plants.

To prevent impetigo, it is useful to clean any wound, be it a scratch or an injury, because they represent a gateway for the bacteria responsible for this skin infection. Furthermore, it is absolutely necessary to avoid contact with anyone who is sick, because this disease is particularly contagious.

Definition

Impetigo is an infection caused by Staphylococcus and Streptococcus Impetigo is an epidermal dermatosis. In fact, it affects the skin, forming lesions in the form of blisters, surrounded by ulcerations. The blisters fill with pus and burst. The lesions are then transformed into a yellowish scab. It is a very common and very contagious disease, especially among children.
Lesions are essentially on the face. They are also found on the hands, neck and scalp.
As impetigo only affects the epidermis, there is no scarring, the scab disappears after treatment.
There is talk of bullous impetigo, more common in children, when the lesions are slightly inflamed, and is generally caused by Staphylococcus aureus.

Impetigo can sometimes turn into ecthyma, a severe form. Lesions are more severe: more inflamed and more ulcerated. In general, ecthyma develops in people whose immune system is “low”. The causative agent of ecthyma is always Streptococcus.

As for those who already suffer from skin diseases such as eczema, scabies or herpes, there is a superinfection with impetigo, which is called impetiginization. This form of impetigo is more common in adults.

Impetigo is a common bacterial disease in infants and children. It is also the most common skin disease caused by bacteria in this age group (children and babies). Although this disease is benign, it is necessary to quickly take care of the sick child and the entire community (family, school environment), as it is highly contagious. It appears mainly in summer, when there are periods of epidemics. In fact, the hot and humid climate at this time favors the transmission of the disease.

Epidemiology

According to the World Health Organization (WHO), this skin infection is more common in developing countries, often due to poor hygiene. In addition, the hot and humid climate allows the transmission of the responsible germs, group A beta-hemolytic streptococci and Staphylococcus aureus. The characteristic lesions of impetigo can develop on intact (healthy) skin, but each lesion (from a game or from mosquito bites) represents a gateway for the bacteria responsible for this disease.

In addition to children, immunosuppressed individuals can also suffer from impetigo, but in these cases, they often deal with ecthyma, the most severe form of impetigo.

According to the Public Health Agency of Canada, over 100 million cases of impetigo are reported worldwide annually.

Causes

The bacteria responsible for impetigo are streptococci, bacteria that can be present in the body, especially in the nostrils. This bacterial skin disease is most commonly caused by group A beta-hemolytic streptococci (Streptococcus pyogenes) and, more rarely, Staphylococcus aureus. These tend to be found more in newborns and infants.

Its mode of transmission differs somewhat according to the bacteria responsible. Beta-hemolytic streptococci are transmitted by direct contact with lesions, while Staphylococcus aureus are transmitted by contact with contaminated lesions and contaminated objects (clothes, dirty hands).

The incubation time is 1 to 10 days.

As impetigo is a common and highly contagious disease, patients need to be isolated. The people most affected by impetigo are children and babies. Thus, once diagnosed, these children must drop out of school during treatment. It is a priority to keep babies away, a population that is especially susceptible to infections. Patients are still contagious one to two days after starting oral antibiotic therapy. The French Ministry of Social Affairs and Health recommends a 72-hour leave after starting antibiotic therapy when lesions are extensive and cannot be protected.

Parents must notify the school so that the infection does not spread further.

people at risk

– In general, impetigo is a disease that mainly affects children and babies. This is the most common bacterial skin disease in children. Impetigo is a highly contagious disease, relatives of children are highly exposed. Thus, the risk groups are: parents, siblings, classmates.

Therefore, it is essential that the sick child be quarantined at the first sign of illness. Parents must promptly notify the classes involved. In crèches, it must be ensured that sick children do not come into contact with babies, who represent a fragile and sensitive population.

Impetigo is more common in developing countries, where lifestyles are often poor. Climate also plays a role in the risk of infection, as the bacteria responsible for this infection thrive more easily in warm, humid climates. It is also worth remembering that the period of contagion of the disease in countries with a temperate climate (western countries) is in the summer, the hot season, the time of epidemics in communities, such as day care centers and schools.

Diabetics and immunocompromised individuals often develop a more serious, more pronounced impetigo called ecthyma.

impetigo symptoms

Impetigo is a skin disease, the symptoms are mainly cutaneous. There is usually no general manifestation (fever and pain, general health is very good).

Symptoms are as follows:

– Erythematous phase (red skin)

– Appearance of superficial blisters (small or large blisters), surrounded by a red circle. It is the characteristic inflammatory halo of the disease. This phase is sometimes barely visible, but it evolves quickly as follows:

– Pus in the blisters (blisters worsen and become wrinkled)

– Blisters burst leaving honey-yellow crusts (called meliceric scabs). These scabs are characteristic of impetigo and aid in the medical diagnosis.

– Itch

– Adenopathy (inflammation of the lymph nodes)

These blisters can appear on the face, ears, scalp, neck and hands.

In general, the lesions first appear in the facial orifices: mouth, nose. Then they generalize to the face and sometimes the rest of the body.

The lesions are generally small (the size of the blisters and then the crusts), but when there are complications, they can become larger due to diffusion and contamination from scratching with dirty hands.

Diagnosis

The doctor will examine the lesions in order to detect the symptoms of impetigo. In fact, impetigo is a bacterial infection of the skin by streptococci and staphylococci, causing characteristic blisters, redness and itching. The blisters burst, leaving yellow, oozing, honey-colored crusts. They are known as meliceric crusts and are particularly characteristic of the disease. However, there is usually no fever or other general signs. The doctor will ask additional questions to trace the history of the disease, the progression of the lesions and prevent it from spreading.

Staphylococcus aureus is often the cause of impetigo in infants and newborns.

In the case of ecthyma, however, it is mainly streptococci.

In principle, in benign forms of impetigo (except ecthyma), it is not necessary to perform a culture of the lesions in order to determine the causative agent of impetigo and to confirm the diagnosis. This test will only be performed in the most severe cases, when impetigo is recurrent or when there is ecthyma (severe form of impetigo, more ulcerative lesions with more crusts). The doctor will perform a collection in the lesions, as well as in the nostrils, where this type of bacteria is usually found.

Complications

In general, impetigo heals very well, despite its easy self-dissemination on the sufferer’s skin. Impetigo is treated with antibiotics in cream or pill form.

Also, because the blisters caused by impetigo only affect the epidermis, there is no scarring.

The main complication of impetigo is an epidemic. Indeed, as this disease is highly contagious. This is the time for the pus-filled blisters to rupture, causing the release of the bacteria that cause impetigo, these being  Staphylococcus and Streptococcus . Thus, the spread of the disease is to be feared. This is why the doctor must determine the complete history of the disease, in order to protect the workplace, daycare, school and family where the patient lives.

When impetigo is caused by Streptococcus , attention must be paid to possible damage to the kidneys due to M proteins secreted by certain Streptococcus .

The disease is not generalized to the whole body (except the skin). This is why, without treatment, ecthyma (the most severe form of the disease) and adenopathy can appear.

After infection, impetigo can in some cases lead to a risk of developing kidney disease or rheumatic fever.

Treatments

Usually, impetigo is a benign disease. The criteria for defining the severity of healthy disease

– Lesions less extensive than the area covered by both palms;

– Less than five points on the body covered by lesions;

– Absence of symptoms such as fever or other infections;

– Slow progression of lesions;

When these criteria are met, we speak of benign impetigo.

The treatment consists of several very specific steps:

– Care and hygiene;

– Quarantine and protection of the patient’s environment (family, and especially the school);

– Treatment such as; local or oral treatment;

– Prevention of glomerulonephritis, the main complication of streptococcal impetigo.

Care and Hygiene

The patient can wash with soap and water, allowing the elimination of bacteria and crusts. Then, an antibiotic ointment can be applied if the treatment is local. Otherwise, Vaseline is sufficient to pass the scabs, if the patient takes an oral course of antibiotics.

Quarantine and protection of the patient environment

If the patient is treated with oral antibiotics, it is necessary that he be quarantined for 48 hours, because after that he is no longer contagious. On the contrary, this is not the case when the treatment is local (antibiotic cream). At this time, the patient should be quarantined until there is a risk of transmitting the disease.

The antibiotic treatment

Impetigo is an infectious disease, it is treatable with topical or oral antibiotics. If the impetigo is extensive, the oral route is preferred.

When the impetigo is benign, that is, the lesions are not so pronounced or very large, a topical antibiotic (in cream) is sufficient. Effective antibiotics in this case are fusidic acid, mupirocin or gentamicin. The treatment lasts from 5 to 10 days, due to the 3 applications per day that are made in adults and, generally, twice a day in children.

If there is no improvement after 48 hours of local treatment, it will be necessary to establish a general treatment with oral antibiotics.

The antibiotics used in oral treatment are from the class of penicillins, cephalosporins and macrolides. These antibiotics are effective against the germs that cause Staphylococcus and Streptococcus impetig . The treatment lasts from 5 to 7 days. The patient is no longer contagious after 48 hours of treatment.

Your doctor may prescribe a complementary treatment to soften the scabs, usually petroleum jelly. These crusts can be removed with pliers. Then we can proceed with disinfecting the scabs. Sometimes a cortisone cream can be applied when the lesions are very inflamed.

Prevention of glomerulonephritis, the main complication of streptococcal impetigo

To prevent glomerulonephritis, the doctor tests the urine for proteins using test strips three weeks after impetigo treatment.

treatment alternatives

Impetigo is a bacterial infection, it is essential to use antibiotics and stay in quarantine, due to its high contagiousness.

Phytotherapy
– Impetigo is a bacterial infection, it is essential to resort to antibiotics and quarantine, given its highly contagious nature. It is highly inadvisable to practice self-medication. Consultation with the doctor is always necessary. Thus, the advice given here should only be used as an adjunct to medications prescribed by the physician.
– The tea tree (melaleuca, tee tree) produces an essential oil known for its antiseptic and healing properties. When there is a skin condition, it is possible to use a mixture that must be applied directly to the lesions three times a day. Avoid eyes and mucous membranes. The formula also contains lavender essential oil and sweet almond vegetable oil. It is contraindicated in patients with sensitivity to one of its components.
– Calendula ointment is recommended externally. Calendula softens scabs and heals the skin very well.

Prevention

– Impetigo is a highly contagious disease, it is necessary to stay away from a person with confirmed impetigo. Simple contact with the lesions can cause the disease. When the infectious agent is Staphylococcus aureus (the most common case in newborns and babies), transmission can be through contaminated objects (clothes, etc.) or dirty hands.

People with impetigo should be quarantined to protect their immediate environment: the school or workplace. The school must be notified immediately in order to contain the epidemic.

Impetigo is transmitted by bacteria, immediate cleaning of wounds, abrasions, and injuries is essential, as they represent entry points for infectious agents. According to the World Health Organization (WHO), it is important to raise awareness among mothers and teachers. Cleaning with soap and water is preferred, followed by disinfection. Recommended disinfectant solutions are: chlorhexidine and povidone iodine.

With regard to povidone iodine, it is first necessary to ensure that the individual is not allergic. It is also possible to use thimerosal or gentian violet.

Cleaning and disinfection must be carried out twice a day in order to keep the skin always clean. To gently loosen the crusts, it is possible to use soapy water.

Tips

– When a person is diagnosed with impetigo, they should be quarantined in order to avoid infecting their family, as impetigo is highly contagious. The quarantine will last for 48 hours after the first dose of an oral antibiotic.

It is important to inform schools, kindergartens, professional and family environments.

– Cleaning is paramount to prevent reinfection, spread of the disease. It will be necessary to wash your hands regularly, cut your nails very short. The bath must be rigorous and daily.

– During treatment, it is advisable to wear loose cotton clothing, to reduce friction and therefore a spread of the disease.

– Finally, if the impetigo is recurrent, it is advisable to take bacteriological samples, in order to determine a specific and really effective antibiotic.

– Sheets, bed linen and towels should be changed regularly.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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