Impetigo - Symptoms and Treatment
A contagious, superficial skin infection, impetigo (impetigo contagiosa) occurs in nonbullous and bullous forms. This vesiculopustular eruptive disorder spreads most easily among infants, young children, and elderly people. It appears most commonly on the face and other exposed areas, usually around the nose and mouth.
Infants and young children may develop aural impetigo, or otitis externa. These lesions usually clear without treatment in 2 to 3 weeks unless an underlying disorder such as eczema is present. Candidal organisms, additional bacteria, fungi, or viruses may complicate lesions in the diaper area. In addition, impetigo may complicate chickenpox, eczema, and other skin disorders marked by open lesions.
Bullous impetigo, which starts as a blister, is caused by coagulase-positive Staphylococcus aureus. Betahemolytic streptococci produce the nonbullous form of impetigo, which later also may harbor staphylococci, producing a mixed-organism infection.
Predisposing factors, such as poor hygiene, anemia, malnutrition, and a warm climate, favor outbreaks of this infection, which most often occur during the late summer and early fall. The most common transmitters appear to be biting insects, such as mosquitoes and flies, and autoinoculation through scratching.
Impetigo usually occurs on the face, neck, arms, and limbs, but the lesions may appear on any part of the body. Impetigo starts as a small vesicle, or fluid-filled lesion. The lesion then ruptures and the fluid drains leaving areas that are covered with the honey-colored crusts. The lesions may all look different, with different sizes and shapes. Your child may also have swollen lymph nodes (small lumps that are located mostly in the neck, arm, under the arm, and in the groin area). The lymph nodes become enlarged when your child's body is fighting an infection.
Impetigo can be diagnosed according to its distinct appearance. A doctor can pinpoint the type of bacteria causing the infection by taking a sample of fluid from a vesicle.
Measures include broad-spectrum systemic antibiotics (usually a penicillinase-resistant penicillin or erythromycin for patients who are allergic to penicillin). Treatment also includes the removal of the exudate by washing the lesions two to three times a day with soap and water or, for stubborn crusts, using warm soaks or compresses of normal saline or diluted soap solution.
Topical agents, particularly mupirocin, have been used successfully in combination with crust removal with each application.
Antihistamines to alleviate itching and daily bathing with bactericidal soaps as a preventive measure are additional treatments.
Good general health and hygiene help to prevent infection. Minor abrasions or areas of damaged skin should be thoroughly cleansed with soap and clean water. A mild antibacterial agent may be applied if desired.
Impetigo is contagious, so avoid skin contact with drainage from impetigo lesions.
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