Impetigo is a very contagious bacterial skin condition which most commonly affects children up to four years of age (approx 3%) but also affects about 2% of children from five to 14 years of age. It’s less common in adults and this is probably due to the nature of close contact children have in creche and school environments. Hands on slobbery play definitely encourages the spread of infection of all types but try telling that to a two year old! There may have been a time a few years ago that I was daft enough to think they may listen!
Impetigo causes sores and blisters on the skin. There are two types of impetigo, one known and bullous and another more contagious form known as non-bullous.
Bullous Impetigo generally causes blisters which can form on the face, chest, back, arms and legs. The blisters are filled with fluid and spread quickly – they can take several days to burst before leaving a yellow crust which is unlike non-bullous impetigo that causes blisters which burst pretty quickly. The blisters can be itchy but are not normally too painful. This type of impetigo can cause a high temperature, swollen glands, and diarrhoea. It does not generally cause scarring but follow my tips below to help reduce the risk.
Non-bullous impetigo mostly affects the skin around the mouth and nose but can occur on the limbs or anywhere on the body. It often starts with a small little blister and then spreads but doesn’t usually become too widespread. It can affect healthy or damaged skin and damaged skin is more susceptible to infection through scratching. The blisters and sores aren’t generally too painful but can be a little itchy. This condition will normally clear up by itself within a couple of weeks. It does not normally cause any scarring but follow my tips below to help reduce the risk!
Non-bullous impetigo is more common than bullous impetigo and is responsible for approximately 70% of cases as it is more contagious. Impetigo that starts on healthy skin is known as primary impetigo whereas impetigo which starts on an area of damaged skin, for example on an area with a wound or eczema, is known as secondary impetigo. The bacteria most commonly to blame for this condition are Streptococcus pyogenes or Staphylococcus aureus.
Tips for management and treatment at home:
- Discourage your child from scratching….good luck with that! Ok..just try your best – consider using scratch mittens on small babies and keep nails short on toddlers and children. Use full length pyjamas when appropriate to stop your child from scratching impetigo on their body.
- Try to clean everything and everyone as much as you can – no easy task if you have a few little ones around! Ensure everyone is washing their hands with warm soapy water.
- Use antibacterial soap.
- Use a clean towel each time you wash and don’t share towels…maybe get extra detergent as the washing machine will be on a lot!!
- Wash the towels and sheets of infected people separately where possible.
- Wash toys when possible
Ok so this is turning into a major cleaning session….I find it helpful to get the kids basins of water so that you can put them on the floor of the kitchen (on a towel to protect your floor!) and give them a sponge and ask them to wash some toys for you – it’s a toddlers idea of heaven – messy play (sort of..)! This way you get their hands clean and the toys get a toddlers best effort whilst you’re off doing the laundry and feeding the dog (ok maybe that’s just my house…!) I’m all about a ‘hands on’ parenting approach when it comes to cleaning!!
See the Doctor if:
- Unfortunately this infection most often requires antibiotic cream so unfortunately I have to advise you to make that trip.
- Contact the doctor again if after treatment with cream the rash continues to worsen.
- If the blisters look like very small pus filled ulcers which have a dark brown crust – this may be ecthyma which is an ulcerated form of impetigo and because it is quite deep can cause scarring.
- If you notice any changes in urine output – so less wet nappies or toilet visits. Or if you notice any body swelling, nausea or headaches as this can be a sign that bacterial toxins are effecting the kidneys.
Impetigo treatment with antibiotic cream is really successful. Some severe cases may require oral antibiotic treatment. Keep your child or baby out of school or creche until the blisters are completely scabbed over or 2-3 days after the start of antibiotic use. Ask your childcare provider what their requirements are but remember you don’t want to spread it to other children who may already have a skin condition and could be affected worse than your child. It’s all about working together to reduce the risk of infection and making your child more comfortable 🙂
I hope you find this helpful and if you have any questions at all please don’t hesitate to contact me by sending a private message to the WonderBaba facebook page (www.facebook.com/wonderbabacare) or by calling me (Sheena) at Milltown totalhealth Pharmacy in Dublin 6 on 012600262. I’m always happy to help!
Impetigo – Lisa S Lewis, MD Attending Physician, Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center