Impetigo

Question 1

What is this condition?

Answer 1

Impetigo

Question 2

What is impetigo?

Answer 2

It is a bacterial skin infection caused by either staph or strep

Question 3

What are the clinical features of impetigo?

Answer 3

• Starts as a blister or pustule which rapidly leaves a honey-coloured crust
• Can occur on any part of the skin
• Usually multiple spots

Question 4

What are the triggers for recurrent impetigo?

Answer 4

• Insect bite
• Skin injuries
• Continuing contacts
• Non compliance with medication
• Children with eczema
• Aboriginal and torres trait islander children

Question 5

What are the types of impetigo?

Answer 5

• Non-bullous-most common- itcy sores with golden crust
• Bullous-large blisters
• Ecthyma- Caused by strep and looks like ulcers and sores

Question 6

How does it spread?

Answer 6

• Spread by touch or by clothes or bedding in contact with an infected person
• Easier spread in schools and child care centres(school sores)

Question 7

Why does impetigo recur?

Answer 7

• Patient might be harbouring staph or strep
• Family members may be harbouring the bacteria
• Non compliance with medications
• Low immune conditions such as diabetes

Question 8

What are the general principles of management of impetigo?

Answer 8

• All children need to be swabbed and sent for culture +MCS
• Soaked clean cloth in half cup of vinegar and apply several times a day, gently wipe off crusts
• A single sore managed with topical mupirocin; multiple sores managed with oral abx such as dicloxacillin/cephalexin for 7-10 days
• Stop spread of infection with waterproof dressing, cutting fingernails short, wash childs linen and clothes separately in hot water, wash hands with soap after touching the sores and keep affected children away from school until all crusts have dried out or atleast 24 hrs after startin Abx and all sores completely covered with dressing
• Educate parents that it is highly contagious, cover all sores with dressing, extremely important to remove crusts, complete antibiotic course and keep off school until all crusts have dired out

Question 9

How to manage recurrent/ hard to treat impetigo?

Answer 9

• Identify the source and swab the sore/nostril where appropriate
• Identify underlying cause of immune suppression such as diabetes
• Daily antibiotic soap or bleach bath to reduce bacterial load
• Treat the source of infection with antibiotic cream/oral Abx
• Prolonged course of oral antibiotic such as cephalexin/flucloxacillin
• Apply mupirocin ointment to the nostril 3 times daily for 7 days if recurrent or hard to treat