Very rarely, kidney problems post-streptococcal glomerulonephritis can be a complication of impetigo. If someone has this complication, it usually starts one to two weeks after the skin sores go away. Learn about post-streptococcal glomerulonephritis. People can get impetigo more than once. Having impetigo does not protect someone from getting it again in the future.
While there is no vaccine to prevent impetigo, there are things people can do to protect themselves and others. Keep sores caused by impetigo covered in order to help prevent spreading group A strep to others. If you have scabies, treating that infection will also help prevent impetigo.
Appropriate personal hygiene and frequent body and hair washing with soap and clean, running water is important to help prevent impetigo. The best way to keep from getting or spreading group A strep is to wash your hands often. This is especially important after coughing or sneezing.
To prevent group A strep infections, you should:. You should wash the clothes, linens, and towels of anyone who has impetigo every day. These items should not be shared with anyone else. After they have been washed, these items are safe for others to use. Skip directly to site content Skip directly to page options Skip directly to A-Z link.
Section Navigation. Facebook Twitter LinkedIn Syndicate. Impetigo: All You Need to Know. Minus Related Pages. Vesicles on an erythematous base that rupture to become erosions covered by crusts, usually on the lips and skin. Papules usually seen at site of bite, which may be painful; may have associated urticaria.
Serum and crusts with occasional vesicles, usually starting on the face in a butterfly distribution or on the scalp, chest, and upper back as areas of erythema, scaling, crusting, or occasional bullae.
Lesions consist of burrows and small, discrete vesicles, often in finger webs; nocturnal pruritus is characteristic. Abrupt onset of tender or painful plaques or nodules with occasional vesicles or pustules. Thin-walled vesicles on an erythematous base that start on trunk and spread to face and extremities; vesicles break and crusts form; lesions of different stages are present at the same time in a given body area as new crops develop.
Information from reference 1. Bullous impetigo most commonly affects neonates but also can occur in older children and adults. It is caused by toxin-producing S. When the bullae rupture, yellow crusts with oozing result.
Systemic symptoms are not common but may include weakness, fever, and diarrhea. Most cases are self-limited and resolve without scarring in several weeks. Bullous impetigo appears to be less contagious than nonbullous impetigo, and cases usually are sporadic. Vesicles or bullae arise from a portion of red plaques, 1 to 5 cm in diameter, on the extensor surfaces of extremities. Widespread vesiculobullous eruption that may be pruritic; tends to favor the upper part of the trunk and proximal upper extremities.
Grouped vesicles on an erythematous base that rupture to become erosions covered by crusts, usually on the lips and skin; may have prodromal symptoms. Nonpruritic bullae, varying in size from 1 to several centimeters, appear gradually and become generalized; erosions last for weeks before healing with hyperpigmentation, but no scarring occurs. Vesiculobullous disease of the skin, mouth, eyes, and genitalia; ulcerative stomatitis with hemorrhagic crusting is most characteristic feature.
Stevens-Johnson—like mucous membrane disease followed by diffuse generalized detachment of the epidermis. No high-quality prognostic studies of impetigo are available. According to two recent nonsystematic reviews, impetigo usually resolves without sequelae within two weeks if left untreated. Seven-day cure rates in these trials ranged from 0 to 42 percent. Acute poststreptococcal glomerulonephritis is a serious complication that affects between 1 and 5 percent of patients with nonbullous impetigo.
Rheumatic fever does not appear to be a potential complication of impetigo. In patients with chronic renal failure, especially those on dialysis and transplant recipients, impetigo can complicate the condition. Other rare potential complications include sepsis, osteomyelitis, arthritis, endocarditis, pneumonia, cellulitis, lymphangitis or lymphadenitis, guttate psoriasis, toxic shock syndrome, and staphylococcal scalded skin syndrome.
The aims of treatment include relieving the discomfort and improving cosmetic appearance of the lesions, preventing further spread of the infection within the patient and to others, and preventing recurrence. Treatments ideally should be effective, inexpensive, and have limited side effects.
Topical antibiotics have the advantage of being applied only where needed, which minimizes systemic side effects. However, some topical antibiotics may cause skin sensitization in susceptible persons. A Cochrane review of interventions for impetigo identified only 12 good-quality studies of impetigo treatment. Three studies found that topical antibiotics are clearly more effective than placebo for the treatment of impetigo. Data from four trials show that they are equally effective.
Adverse effects from topical antibiotics were uncommon and, when present, were mild. Oral penicillin V was no more effective than placebo in a single study of patients with impetigo; however, the study was too small and therefore lacked adequate statistical power to show a clinically meaningful difference between the treatment and placebo groups, if one existed. Numerous studies compared various oral antibiotics. Two systematic reviews showed that lactamase-resistant, narrow-spectrum penicillins; broad-spectrum penicillins; cephalosporins; and macrolides were, in general, equally effective.
According to several systematic reviews, mupirocin was as effective as several oral antibiotics dicloxacillin [Dynapen], cephalexin [Keflex], ampicillin. Oral antibiotics are recommended for patients who do not tolerate a topical antibiotic, and should be considered for those with more extensive or systemic disease. Basic prescribing information is summarized in Table 3. One study comparing fusidic acid and cefuroxime found no difference in effectiveness, and both mupirocin and fusidic acid were consistently more effective than oral erythromycin.
Oral antibiotics can be used, however, based on expert opinion and traditional practice. Children: 90 mg per kg per day, divided, twice daily for 10 days. Cefuroxime Ceftin. Cephalexin Keflex. Children: 90 mg per kg per day, divided, two to four times daily for 10 days. Dicloxacillin Dynapen. Montvale, N. Cost to the patient will be higher, depending on prescription filling fee.
In a small, single study, topical disinfectants, such as hexachlorophene Phisohex , were no better than placebo; and topical antibiotics were found to be superior to topical disinfectants in the treatment of impetigo. Adverse effects from topical disinfectants were rare and, when present, were mild; however, topical disinfectants are not recommended. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Cole earned his medical degree from the University of Maryland School of Medicine, Baltimore, and completed a residency in family medicine at the University of Virginia, Charlottesville, where he also served as chief resident.
He earned his medical degree from Vanderbilt University, Nashville, Tenn. Interested in AAFP membership? Learn more.
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