Infantigo (Impetigo)

Impetigo is an infection usually contracted by young children. It causes red sore like lesions in clusters, often, from 7-15mm in size. These lesions are red when they rupture, and after they break they crust, and form what is classic for the illness- “honey crusted lesions”. The lesions are typically found around the nose and mouth, but can appear anywhere on the body. This condition is very common in babies and children because they touch their faces frequently, and do not have clean hands often. The illness can occasionally clear on its own in a couple weeks, but the potential complications of the illness take a precedence and warrant treatment with an antibiotic. Once taken, the lesions start to clear, but more importantly, the infection is no longer infectious after 48 hours of antibiotic therapy.

How is Impetigo Spread?

As noted, the bacteria is picked up, usually by children’s hands. It can be spread by having contact with someone who is infected, or by touching objects that the infected person has used, such as bedding linen, towels, and toys. In preschools and elementary schools, this infection can spread very quickly, as it can in families as well.

What are the Causes of Infantigo?

infantigo
Impetigo is caused by a bacteria, most commonly staphylococcus aureus. However, it can also be caused by group A streptococcus. Both can be treated with the same antibiotic, but each has different potential complications. A staphylococcal infection can spread in the skin causing what is called a cellulitis. Strep can also do this. However streptococcal infections, if spread into the bloodstream, can infect the kidneys and cause what is called post-streptococcal glomerulonephritis. This is a very serious kidney disease, and it is the main reason that impetigo be evaluated and treated with an antibiotic as soon as possible. The incidence of this kidney disease affects less than 1 child in 100 with strep infection, but these are high odds considering the outcome of kidney failure.

Symptoms of Infantigo

Simple Impetigo

As mentioned earlier, the illness manifests with clear or yellowish blisters (<2cm), usually on the face, around the nose and mouth. Multiple lesions may even start to connect to form a larger lesion. The lesions will quickly rupture, and form a moist red based lesion with a “honey-colored” crust. The child (most are toddlers) will otherwise be feeling normal, or may have some mild illness symptoms such as enlarged lymph nodes and low grade temperatures. As the bacteria is spread by touch, the infection can spread to other parts of the body that the child touches. Hence, the lesions can pop up on any skin surface. This type of impetigo accounts for 70% of the cases.

Bullous Impetigo

This version is less infectious, and is more prominent in neonates. This form causes large blisters on the torso or diaper area. It is the same infection, but a different presentation. The blisters are very thinly roofed, and rupture very easily. The blisters are first filled with clear fluid and then the fluid gets yellow-brown prior to rupture. There is no “honey-colored” crusting in these cases. Then the skin gets a scalded appearance, and a raised rim. Neonates with this form of disease can become quite ill. They can develop systemic symptoms, with fever, weakness, listlessness, and diarrhea. These children require IV antibiotics.

Lastly, impetigo can spread into deeper tissues, and cause what is called Ecthyma. Again, this is the same infection, but as it penetrates into deeper tissue, it causes the formation of pus, and ultimately forms deep ulcerations. This form is much more serious, and much more painful, and often requires hospitalization.

What are the Risk Factors?

  • Age – As mentioned, children age 2-6 are the highest incidence, but any age person can be infected.
  • Poor Hand Washing – When someone is infected, strict and frequent hand washing is critical to prevent the spread of disease, and this is another common reason for the spread in children.
  • Preschools and Elementary School Children – The hygiene of children aside, impetigo spreads in closed areas with many potential contacts, such as preschool, daycare or elementary school classrooms.
  • Broken Skin or Open Wounds – Children who have cuts or sores are more likely to touch that area, and therefore the area around broken skin has a significant risk for spread of impetigo.
  • Skin-Skin Sporting Activities – Since the bacteria is spread by contact with the infected area, or by having contact with objects the infected person touched regularly, it goes to follow that wrestlers, football players, martial artists, and MMA fighters will be in higher risk groups.
  • Season of Higher Spread – The time of year impetigo is spread is during the warmer, and moist seasons. Hence, a humid summer holds the greatest rate of spread. This is the reason Impetigo is much more common in the southeast states.
  • Altered Immune Systems – When people have a poor immune system, and cannot adequately fight infection, impetigo is more prevalent. The more aggressive forms such as ecthyma are prevalent in immunocompromised states, such as diabetes and chemotherapy patients.

How is the Diagnosis made?

The diagnosis is typically made simply on a doctor’s visit after a good history is taken, and a complete exam is done. The affected skin can be swabbed for a culture. This is necessary in cases of uncertainty, of lack of response to treatment, in cases where concern for epidemic is evident, if Methicillin Resistant Staphylococcal Aureus (MRSA) is a concern, and if there is a concern that the child has developed kidney disease. Urinalysis and a full blood work panel is necessary in these cases.

Complications of Impetigo

  • Super-infection of the surrounding skin with another bacteria, causing a cellulitis skin infection. This skin infection can cause blood borne bacteria and produce septic shock.
  • Scar formation can occur if bullous impetigo and ecthyma are present
  • Post Streptococcal Glomerulonephritis is the most concerning problem if a streptococcal infection is the original cause. This can cause permanent kidney damage.

What are Treatments and Home Remedies of Infantigo?

Although typical impetigo can resolve on its own in 2 weeks, due to the risk of spread, worsening of infection, and benefits of treatment outweighing the risks, the preferred approach is to treat with antibiotics as soon as possible. Topical antibiotics can be used for very small and limited infections. For more advanced infection, if the lesions are in multiple places, or the child is developing any other signs of illness, antibiotic oral treatment is needful. If the patient requires hospital stay, IV antibiotics are needed to relieve the infection. It is critical that the patient take all of the antibiotic course. This will prevent antibiotic resistance, and help the infection resolve completely.

Local gentle care can be done with soap and water, and gently wash the crusting lesions off. If pain ensues, simply stop cleansing, and placed a moist cloth atop the affected skin. This care is appropriate for comfort while antibiotics are taken.

Infantigo (Impetigo) Pictures

Infantigo pictures in both adults and children. Impetigo on neck, legs, scalp, lips, nose,etc.

infantigo in children

infantigo pictures

infantigo pictures 2

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