Impetigo is a bacterial infection of the skin. It is highly contagious but not serious. Most cases are reported in children between 2 and 6 years of age. A less known fact is that impetigo can also occur in animals such as puppies.
Common signs of impetigo are vesicles or pustules which quickly rupture and form honey-colored scabs. Once scabs are formed, the infection stops being highly contagious. It is not common for impetigo to cause systematic symptoms like fever, nausea and swollen lymph nodes. When that happens, there is a possibility of impetigo complications.
Signs of impetigo may disappear after a few weeks without treatment. Antibiotics make the infection go away faster and also prevent spread. Home treatments and prevention measures form an important part of overall impetigo treatment.
Signs of early stages of impetigo
The two main types of impetigo are bullous and nonbullous. Bullous is the less common type. Both are caused by same pathogens but present with slightly different signs. Impetigo cream or ointment can be used on either.
During the beginning stages, nonbullous impetigo causes tiny red spots that may gain peripheral area but remain flattened. These spots are actually small blisters filled with clear yellowish fluid or pus. They mostly appear on the face around the mouth and nose but can also occur on the arms, legs and basically anywhere on the skin.
Bullous impetigo causes larger blisters. This type occurs when bacterial toxins cause a gap between the dermis and epidermis. As fluid and pus collect in the formed gap, much larger blisters than those of nonbullous impetigo form. These blisters may be painful and itchy. Bullous impetigo mostly appears on the buttocks, trunk and thighs. Impetigo on arm is also more likely to be bullous.
Early stages of impetigo also involve rupturing of blisters to release the fluid contained inside. The fluid contains a lot of impetigo causing bacteria. Direct contact with it can easily transmit infection. Once ruptured, blisters turn into sores which also are rich sources of bacteria. It is at this stage that impetigo is most contagious.
Later and severe stages of impetigo
Once blisters are ruptured, honey-colored crusts form over. This indicates later impetigo stages near full recovery. The scabs prevent bacteria from being spread during direct skin contact. Full recovery normally occurs without scarring.
Severe impetigo stages are quite different. When impetigo is severe, it means that infection has reached deeper skin layers or has spread extensively. This is not uncommon in the case of impetigo baby infection.
A common severe form of impetigo is known as ecthyma. It is caused by the same bacteria responsible for impetigo. In the case of ecthyma, infection occurs much deeper in the skin. Deeper areas of ulceration occur which get covered by hard crusts. If the crusts are gently removed, red and mildly inflamed ulcerations will be uncovered. Pus usually oozes from the ulcers. Ecthyma usually leaves scars once healed.
Serious symptoms such as fever and nausea may indicate more severe infections like cellulitis. Such require medical treatment with antibiotics. Sometimes, impetigo may be caused by bacterial resistant to some antibiotics. Such infections do not easily resolve without specific oral antibiotics.
During impetigo stages of healing, blisters will crust over. There may be mild swelling and itchiness especially at edges.
How to tell mild impetigo from severe stage infection
In other words, when should you see a doctor for impetigo? As mentioned earlier, impetigo is most common in children. Children may not be able to tell when an infection is getting out of hand. Parents should therefore closely monitor impetigo signs in affected children.
Blistering is common even in mild impetigo. You may be able to see clear yellowish fluid ooze from the blisters. Once ruptured, red sores which may be slightly inflamed will develop. “Golden” scabs soon form over the ruptured blisters.
Severe stage impetigo presents with signs such as pain, swelling, redness, fever, chills and headaches. Below are complications of impetigo which may be indicated by such severe symptoms:
- Cellulitis – this is a potentially dangerous bacterial infection of the skin. It develops deeper in the skin and therefore not contagious. Cellulitis is characterized by redness, swelling, tenderness and warmth. Affected areas may also develop red streaks or dark patches.
- Scarlet fever – scarlet fever mostly occurs as a complication of strep throat but can also be caused by severe impetigo on face. It causes a widespread pink rash accompanied by fever, vomiting and pain. Patients should keep from congested areas not prevent spreading the infection to others. The condition is treatable with antibiotics.
- Guttate psoriasis – guttate psoriasis usually develops as a complication of bacterial infections. It causes tiny crusty patches shaped like a drop. It is not contagious and is treatable with topical medications.
- Staphylococcal scalded skin syndrome – this condition is caused by skin damage resulting from bacterial toxins. It causes large blistered areas, much like what happens with skin damage caused by hot water. Patients usually require immediate medical attention.
- Post-streptococcal glomerulonephritis – it is not common for impetigo to cause this condition. It occurs when blood vessels that supply kidneys with blood become damaged by bacterial toxins. This results in signs such as blood in urine and swelling in face, tummy and feet.
- Septicaemia – this is a form of blood poisoning that occurs when bacterial toxins are released into the circulatory system. It should be treated as a medical emergency because patients can quickly go to septic shock and suffer systematic organ failure. Common signs include low blood pressure, diarrhea, rapid heart rate and confusion.
How long does impetigo last?
How long does impetigo last? Without treatment, impetigo can last up to 2 weeks. This period is significantly reduced when certain antibiotics are used.
Antibiotics have been confirmed in clinical tests to effectively reduce the time it is required for impetigo to heal. The same cannot be said of disinfecting agents. Such may only succeed in keeping impetigo from spreading.
Topical medications such as mupirocin are able to make symptoms go away more quickly when used on mild impetigo or when infection is localized to small areas. For severe or widespread infection, the same results may be achieved with oral medications such as clindamycin.
Topical medications come with several advantages. For example, they require less dosage measurement compared to oral medications. They also do not alter intestinal flora and therefore do not cause side effects such as diarrhea and nausea. Main disadvantages include skin irritation and laborious application.
Oral medications such as amoxicillin for impetigo come with the advantage of the fact that they are effective even on resistant bacteria. Administration is also not as laborious as with topical medications. Their main drawbacks are that they cause side effects such as diarrhea and nausea due to altered intestinal flora and require larger dosage measurements.
Using antibiotics without prescription may lead to bacterial resistance. Patients are always being advised to check with their doctors before using antibiotics. For years since their discovery, antibiotics have been highly successful in treating bacterial infection. It has been noted that aggressive strains of bacteria are emerging which do not respond to some antibiotics. This has been attributed to use of medications without prescription and not completing prescribed medications. Once resistant bacteria have mutated in one patient, they may be passed to several healthy individuals where they will multiply to give rise to even more resistant bacteria.
Within a certain period of time, very aggressive infections that have to be treated with specific medications will develop. This is a major medical crisis that we should do the most we can to avoid. A world without antibiotics is synonymous to a world where a simple infection such as impetigo can prove fatal overnight. Check out more details on impetigo vs MRSA.
What are the causes of recurrent impetigo?
Recurrent impetigo can prove a vexing problem. Unlike skin conditions like atopic eczema, recent history of impetigo is not considered a risk factor. Recurrence in impetigo indicates a potential underlying issue.
A common cause of recurring impetigo is bacterial colonization in nasal passages. A good number of people carry staphylococcus bacteria in their noses without signs of illness. Occasionally, the established colonies may be source of bacteria that are causing skin infection. Antibiotic ointments are used to get rid of such bacteria.
Recurring infection may also be caused by incomplete treatment of a previous infection. When antibiotics are administered, they systematically destroy the bacteria causing infection. Not finishing medications means that some bacteria will be left behind. Due to influence of the immune system, smaller numbers of bacteria may not be able to cause infection. They will therefore take some time to regroup and multiply, resulting in recurring infection.
Another possible cause of recurrent impetigo is weakened immune system. Normally, our bodies are able to recognize harmful bacteria and fight them off from the body. Diseases such as HIV and diabetes rob this natural ability from the immune system. As a result, bacterial infections may keep coming back even after initial successful recovery. Medications meant to manage chronic diseases which may compromise the immune system are available.
Constant presence of risk factors is yet another possible cause of recurring impetigo. Such risk factors include:
- Congested places – impetigo used to be very rampant in schools and day care centers. This is because the infection is highly contagious. If patients are not isolated and properly treated, the infection can keep recurring.
- Skin injuries – bacteria are very small. Even tiny skin injuries invisible to naked eye are excellent portals of entry that bacteria can take advantage of. People with skin conditions like eczema and psoriasis may keep having recurring cases of impetigo.
- Poor hygiene – impetigo doesn’t always require direct skin to skin contact to be transmitted. Something as simple as sharing clothes, bed linen or towels can transmit the infection.
Why is impetigo contagious
How comes that impetigo is so easily transmittable? Why is impetigo contagious? First, we need to understand that impetigo is contagious in two manners. It can be passed to other people and it can be spread to elsewhere in the body.
Impetigo develops very closely to the surface of the skin. This is why it is possible for the infection to begin on intact skin. Developing very closely to the surface of kin means bacteria can easily be picked from a site of infection or be deposited to a surface during contact. This is why impetigo is so contagious.
Another reason is because impetigo blisters always burst open to release pus or fluid. Both the sore left behind and pus are rich sources of impetigo causing bacteria. Impetigo treatment cream can be used to reduce risk of spread. 2 days after starting treatment with antibiotics, impetigo is considered not contagious.
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