Impetigo

Cause

Impetigo is usually caused by infection with the bacterium Staphylococcus aureus. This is the cause in about eighty percent of the cases. However, it’s also possible that the bacterium Streptococcus pygones causes the condition. This occurs in approximately ten percent of the cases. In other cases, the disease develops as a result of infection with both bacteria.
By touching the vesicles and then another part of the body, the disease can spread over the rest of the body. When others touch the sores, they can get infected as well. Scratching the vesicles and then touching someone else with the fingers, can transfer the virus too.
Infection can also occur by sharing objects. The moisture that comes out of the vesicles can easily be left on objects. By sharing bed linen, towels, clothing, razor blades or toys, the bacteria can spread easily. A person can infect others as long as the vesicles are oozing.

Symptoms

One to three days after infection, the first symptoms will occur. In the face or neck, a rash will develop which can then spread all over the body. It may eventually even arise on the soles of the feet, on the scalp or under the armpits. Often, however, the rash will be limited to the face and neck and is the worst around the mouth and nose. First, the rash will only be made up of small red bumps, but later also vesicles will emerge. These vesicles are filled with pus and usually it gets out. This will dry in to scabs. The rash, made up of bumps, vesicles and scabs, is for many people a cosmetic problem. The size of the rash may vary from a few millimeters to some centimeters.

Diagnosis

The diagnosis of impetigo can almost always be made on the appearance of the spots. In case of doubt and severe infections, a culture can be taken with a cotton swab. If the diagnosis is not clear and it might also be another condition, a piece of tissue (skin biopsy) is sometimes taken for microscopic examination.

Treatment

Impetigo will heal more rapidly when it’s being treated. Chances of contamination are also a lot smaller then. In most cases, the general practitioner will prescribe antibiotics to counteract the infection. Especially for children it’s even more important to seek treatment, because they can rapidly infect others.
The doctor will usually prescribe an antibiotic in the form of a cream or ointment. The doctor usually chooses a cream or ointment with fusidic acid or tetracycline. The risk of infection has disappeared after 48 hours from first use. If the vesicles are open, the antibiotic works best. Sometimes, the doctor chooses to prescribe an ointment or cream with hydrocortisone or mupirocin as well, if previously mentioned drugs don’t work sufficiently.
In some people, the vesicles expand further and further. Others are very ill or have a poor immune system. In these people, it’s important that they heal as quickly as possible and then the doctor will prescribe antibiotics in the form of tablets.

Prognosis

Impetigo will heal on its own after one to three weeks. Afterwards, no scars will be left. People have often become immune if they have had the condition once. In some people, however, the impetigo may recur when they have a very poor immune system.

Considerations

• The healing process can be stimulated by good hygiene, not scratching and touching the rash as little as possible. This can prevent the virus from spreading further.
• A person can choose to lubricate zinc ointment to the rash. The ointment will reduce the itch and vesicles will dry in more rapidly. In addition, the vesicles will heal faster, because the ointment ensures no or less scratching the vesicles.

Facts

• The term ‘impetigo’ originally means ‘from the beginning’. The disease is named so, because it’s scabby from the beginning.
• The prevalence of impetigo is 2%.
• Nowadays, impetigo appears to be three to four times more common than before and it occurs especially in late summer and autumn.
• Unlike before, impetigo occurs mainly in the higher social class now.