Impetigo

Impetigo is a highly contagious bacterial skin infection that primarily affects infants and young children. It causes red sores that quickly rupture, ooze, and form characteristic honey-colored (golden-yellow) crusts. **Key Facts:** - **Cause:** Staphylococcus aureus (most common) or Streptococcus pyogenes bacteria - **Appearance:** Red sores → blisters → honey-colored crusts - **Most affected:** Children ages 2-5, but can occur at any age - **Highly contagious:** Spreads through direct contact with sores or contaminated items - **Easily treated:** Antibiotics (topical or oral) clear infection in 7-10 days **Two Main Types:** 1. **Non-bullous impetigo (most common - 70%):** Small blisters that rupture quickly, leaving honey-colored crusts 2. **Bullous impetigo:** Larger, fluid-filled blisters that take longer to rupture; caused by toxin-producing staph **How It Spreads:** - Direct skin-to-skin contact with sores - Touching items contaminated with the bacteria (towels, clothing, toys) - Scratching, which spreads the infection to new areas - Can enter through cuts, scrapes, insect bites, or eczema patches **Important:** Impetigo is NOT a sign of poor hygiene. The bacteria that cause it are common and can infect anyone.

**How Impetigo Develops:** **1. Bacterial Entry:** Staphylococcus aureus or Streptococcus pyogenes bacteria enter the skin through a break — a cut, scrape, insect bite, or even microscopic cracks in dry or irritated skin. In children with eczema, the compromised skin barrier makes infection more likely. **2. Superficial Infection:** Unlike cellulitis (which goes deep), impetigo affects only the outermost layer of skin (epidermis). The bacteria multiply rapidly in this superficial layer, causing blisters to form. **3. Blister Formation and Rupture:** The blisters (vesicles or bullae) contain bacteria and fluid. When they rupture — from scratching, rubbing, or on their own — the highly infectious fluid spreads to surrounding skin. **4. Crust Formation:** As the fluid dries, it forms the characteristic honey-colored crusts. These crusts are teeming with bacteria, making them very contagious. **5. Spread:** Without treatment, children often spread the infection to other body parts by scratching and touching, and to other people through close contact or shared items. **Risk Factors:** - Age 2-5 years (immature hygiene habits, close play with other children) - Warm, humid weather (bacteria thrive in moisture) - Crowded conditions (daycare, schools) - Pre-existing skin conditions (eczema, scabies, chickenpox) - Cuts, scrapes, or insect bites - Contact sports (wrestling) - Poor skin hygiene

**Antibiotic Treatment (Required):** **Topical Antibiotics (First-line for limited disease):** - **Mupirocin (Bactroban):** Apply to sores 3 times daily for 5-7 days. Most effective topical option. - **Retapamulin (Altabax):** Apply twice daily for 5 days. Alternative to mupirocin. **Oral Antibiotics (For widespread or severe cases):** - **Cephalexin (Keflex):** 25-50 mg/kg/day divided into doses for 7 days - **Dicloxacillin:** 12.5-25 mg/kg/day for 7 days - **Amoxicillin-clavulanate (Augmentin):** If mixed infection suspected - **Clindamycin or TMP-SMX:** If MRSA is suspected in your area **Hygiene Measures (Important adjunct to antibiotics):** - Gently wash sores with soap and water 2-3 times daily - Remove crusts gently after soaking (helps antibiotic penetration) - Apply antibiotic ointment - Cover with loose bandage - Wash hands after touching sores - Wash bedding, towels, and clothing in hot water daily **School/Daycare Return:** - Child can return 24 hours after starting antibiotic treatment - Keep sores covered when around others