Definition

Impetigo refers to a very localized bacterial infection of the skin. There are two types, bullous and epidemic.

  Description

Impetigo is a skin infection that tends primarily to afflict children. Impetigo caused by the bacterium Staphylococcus aureus (also known as staph) affects children of all ages. Impetigo caused by the bacteria called group A streptococci (also know as strep) are most common in children ages two to five.

The bacteria that cause impetigo are very contagious. They can be spread by a child from one part of his or her body to another by scratching, or contact with a towel, clothing, or stuffed animal. These same methods can pass the bacteria on from one person to another.

Impetigo tends to develop in areas of the skin that have already been damaged through some other mechanism (a cut or scrape, burn, insect bite, or vesicle from chickenpox).

  Causes and symptoms

The first sign of bullous impetigo is a large bump on the skin with a clear, fluid-filled top (called a vesicle). The bump develops a scab-like, honey-colored crust. There is usually no redness or pain, although the area may be quite itchy. Ultimately, the skin in this area will become dry and flake away. Bullous impetigo is usually caused by staph bacteria.

Epidemic impetigo can be caused by staph or strep bacteria, and (as the name implies) is very easily passed among children. Certain factors, such as heat and humidity, crowded conditions, and poor hygiene increase the chance that this type of impetigo will spread rapidly among large groups of children. This type of impetigo involves the formation of a small vesicle surrounded by a circle of reddened skin. The vesicles appear first on the face and legs. When a child has several of these vesicles close together, they may spread to one another. The skin surface may become eaten away (ulcerated), leaving irritated pits. When there are many of these deep, pitting ulcers, with pus in the center and brownish-black scabs, the condition is called ecthyma. If left untreated, the type of bacteria causing this type of impetigo has the potential to cause a serious kidney disease called glomerulonephritis. Even when impetigo is initially caused by strep bacteria, the vesicles are frequently secondarily infected with staph bacteria.

Impetigo is usually an uncomplicated skin condition. Left untreated, however, it may develop into a serious disease, including osteomyelitis (bone infection), septic arthritis (joint infection), or pneumonia. If large quantities of bacteria are present and begin circulating in the bloodstream, the child is in danger of developing an overwhelming systemic infection known as sepsis.

  Diagnosis

Characteristic appearance of the skin is the usual method of diagnosis, although fluid from the vesicles can be cultured and then examined in an attempt to identify the causative bacteria.

  Treatment

Uncomplicated impetigo is usually treated with a topical antibiotic cream called mupirocin. In more serious, widespread cases of impetigo, or when the child has a fever or swollen glands, antibiotics may be given by mouth or even through a needle placed in a vein (intravenously).

  Prognosis

Prognosis for a child with impetigo is excellent. The vast majority of children recover quickly, completely, and uneventfully.

  Prevention

Prevention involves good hygiene. Handwashing; never sharing towels, clothing, or stuffed animals; and keeping fingernails well-trimmed are easy precautions to take to avoid spreading the infection from one person to another.

   Key Terms:

Systemic Involving the whole body; the opposite of localized. Ulcer An irritated pit in the surface of a tissue. Vesicle A bump on the skin filled with fluid.

   Resources:

Books

• Darmstad, Gary L., and Al Lane. "The Skin." In Nelson Textbook of Pediatrics, ed. Richard E. Behrman. Philadelphia: W. B. Saunders Co., 1996.
• Deresiewicz, Robert L., and Jeffrey Parsonnet. "Staphylococcal Infections." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
• Sherrill's Medical Microbiology: An Introduction to Infectious Diseases. 3rd ed. Ed. Kenneth J. Ryan. Norwalk, CT: Appleton & Lange, 1994.
• Stevens, Dennis L. "Infections of the Skin, Muscle, and Soft Tissues." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
• Stoffman, Phyllis. The Family Guide to Preventing and Treating 100 Infectious Diseases. New York: John Wiley & Sons, 1995.
• "Streptococci." In Sherrill's Medical Microbiology: An Introduction to Infectious Diseases. 3rd ed. Ed. Kenneth J. Ryan. Norwalk, CT: Appleton & Lange, 1994.

Periodicals

• "Bullous Impetigo." Archives of Pediatrics and Adolescent Medicine 151, no. 11 (Nov. 1997): 1168+.
• Huerter, Christopher, et al. "Helpful Clues to Common Rashes." Patient Care 31, no. 8 (30 Apr. 1997): 9+.
• Squires, Sally. "What Your Child Could Catch At School This Year." Good Housekeeping, Sept. 1996, 138+.