If you had chicken pox as a child, you may remember your mother telling you not to scratch. She wasn't just trying to test your willpower, she was protecting you from impetigo, a highly contagious skin infection that occurs when bacteria enters the skin through a cut or abrasion. It affects mostly infants and young children and isn't usually serious, but it can be uncomfortable and unsightly.
Impetigo is usually caused by one of two bacteria: group A streptococcus or staphylococcus aureus. Nonbullous impetigo or impetigo contagiosa is caused by group A streptococcus and begins as tiny blisters, usually on the face around the nose and mouth, which eventually burst and leave small patches of red skin that may weep fluid. These patches gradually dry into a tan or yellowish-brown crust that looks as if it has been coated with honey or brown sugar. Your child will probably not have a fever with this type of impetigo, but he or she may have swollen lymph nodes in the affected area. Nonbullous impetigo usually clears up within two weeks without treatment and without scarring.
Bullous impetigo is caused by staphylococcus aureus and appears as larger fluid-filled blisters on the trunk, arms, and legs that first appear clear, then cloudy. These blisters are more likely to stay intact longer without bursting. If your child has this type of impetigo, he or she may also have a fever, diarrhea, and general weakness. Bullous impetigo will usually last much longer than nonbullous impetigo.
Ecthyma is a rarer and more serious form of impetigo that occurs when the infection penetrates deep into the skin's second layer. Your child may have painful pus-filled sores, usually on the feet and legs, which turn into deep ulcers, and a hard, thick, gray-yellow crust covering the sores. He or she may also have swollen lymph nodes in the affected area and scars that remain after the ulcers heal.
Children get impetigo by coming into contact with an infected individual or simply by touching an object that has come into contact with someone with the bacteria, such as a towel, clothing, or a toy. The bacteria then enter through a cut or other skin abrasion, although it is possible for the bacteria to affect healthy skin (a less common condition called primary impetigo). Impetigo is very commonly seen during warm, humid weather and in children suffering from chicken pox.
Impetigo usually is not dangerous; however, it can sometimes lead to serious complications, including kidney inflammation, meningitis, and cellulitis, so it's important to have your child examined by a doctor at the first sign of impetigo.
The doctor will probably diagnose impetigo simply by examining your child; however, if there is any doubt about the diagnosis, he or she may take a culture from one of the sores to determine the bacteria involved.
Antibiotics are used to treat both types of impetigo and your doctor will prescribe either topical or oral, depending on the severity of the infection and the location. Bacteria live under the yellow-brown scabs, so removing them will help the topical antibiotic to work. Twice a day, gently wash away the scabs with water and an antiseptic solution, then pat the area dry (use a clean towel each time and do not let anyone use it after). Your child will no longer be contagious 48 hours after he begins the antibiotics and the rash begins to visibly clear; however, be sure to complete the entire prescription of antibiotics to prevent the infection from recurring.