Impetigo, contagious but not dangerous

Donya Betancourt, Pediatrician, drdonya@hotmail.com

When you have children, sooner or later you will need to deal with rashes and skin irritations. Today we will talk about impetigo, one of the most common skin disorders.

Impetigo is a skin infection that usually appears on the face, especially around the nose and mouth. It is usually caused by the bacterium Staphylococcus aureus or Streptococcus pyogenes (Group A beta-hemolytic streptococcus). Both types of bacteria can live harmlessly on your skin until they enter through a cut or other wound and cause an infection.

In adults, impetigo is usually the result of skin injury often caused by another skin problem like dermatitis. Children are commonly infected through a cut, scrape or insect bite, but they can also develop impetigo without having any damage to the skin.

Children are especially susceptible to infections because their immune systems are still developing. These bacteria flourish wherever groups of people are in close contact, meaning impetigo spreads easily in schools and child-care settings through direct contact with another person, a contaminated towel, bedding or clothing.

Impetigo is highly contagious, and scratching or touching the sores is likely to spread the infection to other body parts as well as to other people.

There are a few types of impetigo: * Impetigo contagiosa is the most common, which usually starts as a red sore on your child's face. It is often found around the nose and mouth. The sore ruptures quickly, oozing either fluid or pus that forms a honey-colored crust. When the crust disappears, it leaves a red mark that heals without scarring. The sores may be itchy but are not painful.

Since the infection is extremely contagious, touching or scratching the sores can cause it to spread to other parts of your child's body. * Bullous impetigo primarily affects children younger than two, and infants. It causes painless blisters usually on the trunk, arms and legs. The blisters may be large or small and may last longer than sores from other types of impetigo. Bullous impetigo may cause other signs and symptoms, including fever, diarrhea or general weakness. * Ecthyma is a more serious form of impetigo in which the infection penetrates deep into the skin's second layer (the dermis). There are painful fluid or pus-filled sores that turn into deep ulcers, usually on the legs and feet and have a hard, thick, gray-yellow crust covering the sores, plus swollen lymph glands in the affected area. Scars are left after the ulcers heal.

Although impetigo is not dangerous, it may lead to serious complications if it is not treated or controlled. These are: * Poststreptococcal glomerulonephritis (PSGN). This kidney inflammation may develop after a streptococcal infection such as strep throat or impetigo. It occurs when dead bacteria and antibodies become trapped in the small tubes that filter waste in your kidneys (glomeruli). Although most people recover without any lasting damage, PSGN can sometimes lead to kidney failure. * Meningitis. This is a serious infection and inflammation of the membranes and fluid surrounding your brain and spinal cord.

Newborns with bullous impetigo are especially at risk. Meningitis usually starts suddenly with a high fever, severe headache and vomiting. The disease is fatal in about 10 percent of cases. * Cellulitis. This potentially serious infection affects the tissues underlying your skin and eventually may spread to your lymph nodes and bloodstream. Left untreated, cellulitis can quickly become life-threatening.

The treatments for impetigo may vary depending on your child's age, the type of impetigo and the severity of the infection.

Treatments include maintaining hygiene -- by keeping your child's skin clean and bacteria-free you can help mild infections heal on their own, topical antibiotics like mupirocin ointment (Bactroban), or oral antibiotics, especially for ecthyma and severe cases of impetigo contagiosa.

Be sure to finish the entire course of medication even if your child seems to be getting better. This helps prevent the infection from recurring and makes it less likely that bacteria will become resistant to the antibiotics. Keeping your child's skin clean is the best way to keep it healthy. Bathe your child daily using soap and water, and treat cuts, scrapes, insect bites and other wounds right away to prevent infection.