impetigo, impetigo contagiosa


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(im″pĕ-tī′gō )
[L. impetigo, a scabby eruption on the skin]
A contagious bacterial infection of the epidermis characterized by yellow to red, weeping and crusted or pustular lesions, esp. around the nose, mouth and cheeks, or the extremities.
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impetiginous (im″pĕ-tij′ĭ-nŭs)
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, adj.

The disease is common in children and adults and may develop after minor skin irritation or trauma. Impetigo spreads easily from person to person, e.g., among infants and children who play together, or among older adults, e.g., in nursing homes. It often complicates atopic dermatitis (AD), because AD stimulates scratching.

Impetigo is caused by infection of the skin with group A beta-hemolytic streptococci or staphylococci.

Common symptoms include oozing, itching, burning and scabbing of the skin. Regional lymph nodes sometimes enlarge in response to the infection. Glomerulonephritis is a rare but serious complication.

Impetigo is diagnosed based on its clinical appearance. Cultures are not usually needed.

Careful handwashing by patients and caregivers and the use of Standard Precautions prevents the spread of impetigo in clinical environments.

Topically applied mupirocin ointment, fusidic acid, or oral agents (beta-lactamase resistant antibiotics effective against staphylococcus and streptococcus) are used to treat the infection. Mupirocin also eliminates nasal carriage of the offending organisms.

With appropriate and timely treatment, the vast majority of patients recover fully within 3 to 5 days.

The appearance, location, and distribution of lesions are documented, along with any associated symptoms (pruritus, pain). Family members are taught to keep the skin clean and dry, removing exudate 2 to 3 times daily by washing the lesions with soap and water; warm saline soaks or compresses may be applied to remove stubborn crusts. Patients and families are taught the importance of not sharing washcloths, towels, or bed linens; the need for thorough handwashing and frequent bathing with a bactericidal soap; and the urgency for early treatment of any purulent eruption to limit spread to others.

Prescribed treatment must be continued for the full course of the prescription even if lesions have healed. Nonprescription antihistamines may be used to reduce itching. The fingernails should be cut and, if necessary, mittens applied to prevent further injury, if the patient is unable to avoid scratching. Diversional activities appropriate to the patient's developmental stage are encouraged to distract from local discomforts. Black patients may develop deeper inflammation than whites and should be informed that this may result in hypopigmentation or hyperpigmentation changes after the inflammation has subsided. The school nurse or employer is notified of the infection, and family members are checked for evidence of impetigo. The patient can return to school or work when all lesions have healed.

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