Impetigo is a common bacterial infection for children ages 2 to 5, and more likely for a child with pre-existing skin condition such as eczema. Today’s article aims to find out more about impetigo, its signs (how to recognize it early), its treatment, prevention and the correlation between impetigo and eczema/atopic dermatitis.
What is Impetigo?
Impetigo is a skin infection that is caused by bacteria (i) Staphylococcus aureus or (ii) Streptococcus pyogenes (same as that causing strep throat). Methicillin-resistant Staphylococcus aureus (MRSA) also causes impetigo. Impetigo is contagious and affect preschoolers most often.
Should impetigo appear as large blisters, it is known as bullous impetigo or non-bullous impetigo if they are crusted. Non-bullous impetigo is more common, often starting out as tiny blisters, then bursting to become wet patches of reddened weeping skin. It then form a yellowish crust.
Signs of Impetigo
Blisters or sores on the face (nose, mouth), neck, hands, forearms and diaper area – these areas are within easy ‘scratching’ reach and often carries more bacteria from contact with surfaces with bacteria. The blisters burst and form a yellowish crust. Impetigo can also present as folliculitis, whereby the hair follicles also blister and burst to become wet patches. Impetigo may also be itchy and be painful if it occurs around lymph nodes. In a study, the areas most commonly infected by impetigo are the head and neck (65.4%), followed by 19.6% on an upper extremity and by 7.5% each on the trunk and a lower extremity.
Treatment of Impetigo
For localized, yet to spread impetigo, antibiotic ointment can help (mupirocin (Bactroban) or fusidic acid) . For more widespread impetigo, oral antibiotic is prescribed for a faster recovery (few days versus few weeks) and control of the blisters. The area has to be washed and covered up to prevent scratching and spreading the bacteria to other parts of the body. Generally, after 48 hours of antibiotic treatment, the child may be cleared to return to preschool.
Prevention of Impetigo
As impetigo is caused by bacteria, good hygiene such as hand-washing, not touching other surfaces, biting fingers, scratching can help prevent it. For children with eczema, it is good to bring them for swimming, consider cleaning with chlorhexidine or bleach bath in order to keep the bacteria count low and minimize the chance of skin infection. As there is staph bacteria present in the nose, children should refrain from ‘digging’ nose and touching the rest of the body. Fingernails should be kept short and ensure no sharing of towels, bed linen or clothing with other family members.
Impetigo and Eczema
Impetigo is more likely to affect children with already a weakened skin barrier, either generalized as in eczema or localised as in insect bites, cuts or rashes from contact allergens. As it is spread by contact with the bacteria, it most often affects children who scratch, thus often affecting eczema kids. For children in hot and humid climate/ during summer, the likelihood of impetigo infections is higher (higher chance of insect bites, scratching). Eczema skin is more often colonized with staph bacteria and for those with history of eczema herpeticum, the impetigo infection may be via MRSA bacteria.
All in, impetigo is a condition that parents with eczema kids should definitely be aware of. Especially if your child, like mine, live in hot, humid climate, goes to preschool and scratches/bites and simply can’t follow good hygiene! (did I hear a ‘bummer’ from one of you?)