Impetigo is a common bacterial skin infection that is estimated to affect 11 to 15 per cent of Canadians at any one time. Most often it is a childhood infection, especially among children younger than age six, but adults can also be infected
The infection does not mean that the infected person is from a “dirty” home, but rather that bacteria have infected a damaged portion of skin.
The skin is the body’s largest organ. Its job is to cover us and protect us from harm. The skin deals naturally with a complex biosystem of micro-organisms including viruses, bacteria, fungi and even parasites such as dust mites.
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The epidermis or outermost layer of skin provides a physical barrier against infection while sebaceous and sweat glands secrete substances that retard the growth of micro-organisms. The skin also contains immune system factors such as Langerhans’ cells, mast cells and macrophages which can effectively battle micro-organisms.
The most common bacteria that cause impetigo are Staphylococcus aureus and Streptococcus pyogens, which is also known as group A streptococcus. About 30 per cent of people have S. aureus normally in their noses and these organisms can act as a reservoir for the infection. Any damage to the skin such as breaks in the skin, even small ones, or insect bites, cuts or scrapes can allow these bacteria to flourish, causing the infection.
Excessive exposure to water through sweating, bathing, increased skin temperature or scrubbing the skin can reduce the skin’s ability to protect against these bacteria and increase the risk for impetigo. Pre-existing skin conditions such as burns, scabies and eczema may lead to irritated skin and scratching, again resulting in skin damage.
Children are most often affected because they regularly come into contact with each other, meaning they more readily spread the infection. Crowding, poor personal hygiene and warm humid conditions can also contribute. While adults are less commonly affected, individuals who have impaired immune systems or are slow to heal, such as those with HIV infections, or even diabetes, may be at increased risk.
Impetigo occurs first as small lesions that blister, then ooze with an exudate and finally crust over. The crusts appear “honey coloured.” There can be redness, tenderness and itching. Impetigo is seen most often on the face, legs and arms. If there are only a few lesions, a topical antibiotic cream is usually recommended, but if impetigo is widespread or involves large blisters, then oral and even IV antibiotics may be needed.
Before applying an antibiotic cream, the impetigo crusts should be removed by using warm water or saline compresses or washing them gently with soap and water. Touching, scratching or even picking the lesions can spread the infection, but this might be difficult for children to resist. Washing the infected person’s clothing, towels and bedding is often recommended in order to prevent infecting others.
While usually considered a minor problem, complications can occur if impetigo spreads to other parts of the body beyond the skin. Kidney inflammation, more extensive skin infections such as cellulitis, bone infections or osteomyelitis, pneumonia, septic arthritis and septicemia are all possible. Ideally, impetigo should be treated thoroughly and in a timely fashion to prevent complications and its spread.
