Impetigo is a serious skin infection prevalent in young children and infants. Impetigo treatment takes 7 to 10 days for the condition to heal properly.

Impetigo

Overview

Impetigo is a common and contagious skin infection. Bacteria such as Staphylococcus aureus and Streptococcus pyogenes infect the epidermis, the outer layer of the skin. The face, arms, and legs are most commonly affected in impetigo.

Impetigo can affect anyone, although it is more common in children, particularly those aged 2 to 51. Impetigo is the most frequently occurring bacterial skin infection in children and the third most frequent skin condition overall, after dermatitis and viral warts2.

The illness commonly begins in tiny cuts or a rash i.e. anywhere the skin is broken. However, it can also develop on healthy skin. Although impetigo normally recovers on its own in two weeks without scarring, treatment can help ease pain, enhance physical appearance, and prevent the spread of organisms that may cause other diseases. 
&nbsp;

It is known as primary impetigo when it infects healthy skin and secondary impetigo when it develops in broken skin. 
&nbsp;

The term &quot;impetigo&quot; originated in 14th-century England from the Latin word impetere, which means &quot;to attack&rdquo;. Bacteria grow in warm, damp environments. Therefore, impetigo is a seasonal disease, peaking in the summer, and fall in northern climates. In warm, humid climates, it is common throughout the year.

According to a 2015 review, globally, more than 162 million children have impetigo at any one time3. It is important that the review excluded Australia, New Zealand, and North America, i.e. the numbers stated might be an underestimation of the true prevalence of disease.

Impetigo is more frequent in developing countries and low-income regions of developed ones. Areas such as Oceania, which includes Australia, New Zealand, and several other countries, have the highest number of cases1. 
&nbsp;

Impetigo is classified into three categories based on the bacteria that cause them and the sores that develop. Each type progresses through a set of stages. 
&nbsp;

<h5>Nonbullous</h5>

Nonbullous impetigo is primarily caused by Staphylococcus aureus. According to a 2014 analysis, it is the most common type of impetigo, responsible for an estimated 70% of occurrences1. 
&nbsp;

The stages are as follows:

<ul>
	<li>The symptoms usually begin with reddish, itchy blisters around the mouth and nose.</li>
	<li>The sores rupture, leaving red and inflamed skin around them.</li>
	<li>A brownish-yellow crust develops.</li>
	<li>When the crusts heal, reddish spots appear that eventually vanish and do not leave any scars. 
	&nbsp;</li>
</ul>

<h5>Bullous</h5>

Bullous impetigo is almost typically caused by the Staphylococcus aureus bacteria.

<ul>
	<li>It forms bigger blisters, or bullae, filled with a clear fluid that may become darker and cloudy with time. The blisters develop on undamaged skin and are not surrounded by reddish patches.</li>
	<li>The blisters turn soft and transparent before they burst.</li>
	<li>A yellowish, crusty sore typically appears over the area the blisters ruptured.</li>
	<li>When blisters heal, they typically leave no scars behind. 
	&nbsp;</li>
</ul>

<h5>Ecthyma</h5>

This infection is more severe but far less common. It happens occasionally when impetigo is not treated. Ecthyma is more dangerous than other types of impetigo as it penetrates deeper into the skin.

<ul>
	<li>The infection causes painful blisters to develop on the skin of the buttocks, legs, ankles, thighs, and feet.</li>
	<li>Blisters become pus-filled lesions with a thicker crust.</li>
	<li>The skin around the lesions frequently turns red.</li>
	<li>Ecthyma sores heal slowly and may leave scars behind. 
	&nbsp;</li>
</ul>

<h5>Is Impetigo Herpetiformis Same As Impetigo?</h5>

The severe, widespread pustular dermatosis known as impetigo herpetiformis is often linked to pregnancy. The name is problematic as it has nothing to do with &quot;impetigo&quot; which occurs due to herpes virus or bacterial infections. It is mostly seen in patients who have never had psoriasis before pregnancy. 
&nbsp;

Signs and Symptoms

The signs and symptoms of impetigo depend upon the seriousness of the infection. 
&nbsp;

<h5>Common Symptoms of Impetigo</h5>

<ul>
	<li>The skin itches and becomes red.</li>
	<li>A collection of blisters develops, most typically around the nose and mouth.</li>
	<li>The blisters rupture and leak a clear fluid or pus.</li>
	<li>An elevated and wet-looking crust forms over the sore.</li>
	<li>The &lsquo;honey-colored&rsquo; scab dries and slips off.</li>
	<li>The skin fully heals without scarring after some days. 
	&nbsp;</li>
</ul>

<h5>Symptoms of Severe Impetigo Infection</h5>

If large regions of the skin are damaged, signs may include the following:

<ul>
	<li>Fever</li>
	<li>Swollen lymph glands</li>
	<li>A general feeling of weakness or not feeling good (malaise). 
	&nbsp;</li>
</ul>

Causes

Impetigo is a bacterial infection caused by staphylococcus (staph) or streptococcus (strep) strains. These microorganisms can enter your body through an opening in your skin from a cut, scratch, insect bite, or rash.

Impetigo is a highly infectious disease. You can catch these specific bacteria if you touch the lesions of a person with impetigo or if you touch things used by the individual such as towels, clothes, or sheets. However, these bacteria are also widespread in our environment, and most people who come into contact with them will not necessarily acquire impetigo.

&nbsp;

Some people typically have staph bacteria on the inside of their noses. They may develop an infection if the bacteria spreads to their skin.

Adults and children are more likely to get impetigo if they: 
&nbsp;

<ul>
	<li>Live in a hot, humid climate.</li>
	<li>Have diabetes.</li>
	<li>Have a weakened immune system due to viral diseases such as HIV or AIDS.</li>
	<li>Have skin problems, for example, eczema, dermatitis, or psoriasis.</li>
	<li>Have a sunburn or different sorts of burns.</li>
	<li>Suffer from itchy infections, like lice, scabies, herpes simplex, or chickenpox.</li>
	<li>Have bug bites or poison ivy.</li>
	<li>Participate in contact sports. 
	&nbsp;</li>
</ul>

<h5>Incubation Period of Impetigo</h5>

The incubation period is the interval between being exposed to the pathogen (bacteria) and the development of signs and symptoms of the infection. The incubation time period is typically one to three days for streptococcal infections and four to ten days for staphylococcal infections. 
&nbsp;

Diagnosis

A healthcare expert can identify impetigo based on the appearance of the sores. The provider may collect a sample of skin to send to a laboratory. Pathologists can detect which bacterium is causing the infection. This can aid in the selection of the most appropriate medication. 
&nbsp;

If you or your kid observes any blood or an unusual colour in the urine, notify your healthcare professional immediately. 
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Treatment

Prior to commencing treatment for Impetigo , your primary care physician will rule out other&nbsp; serious diseases&nbsp; e.g. <a href="https://merisehat.pk/disease/cellulitis">cellulitis</a>.

Once the diagnosis is confirmed, then your doctor will prescribe the following treatments depending on your specific situation. 
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<h5>Topical Antibiotic Cream or Placebo Cream</h5>

If you have impetigo, doctors can recommend antibiotic creams to promote your recovery or oral antibiotics if it is severe. Topical antibiotics have the benefit of being applied only where they are needed, which reduces the likelihood of systemic side effects. On the other hand, some topical antibiotics may cause skin irritation in sensitive individuals.2

In some cases, the doctor might be able to recommend a non-antibiotic plain cream (placebo). However, topical antibiotics are clearly better than a placebo for the treatment of impetigo. Most individuals with the localised disease should receive mupirocin (Bactroban) or fusidic acid (not available in the US), which are both therapeutic and well tolerated. 
&nbsp;

<h5>Oral Antibiotics</h5>

Several studies compared different oral antibiotics. Two systematic evaluations found that lactamase-resistant, narrow-spectrum penicillins, broad-spectrum penicillins, cephalosporins, and macrolides were all equally effective and beneficial2. 
&nbsp;

Penicillin V and amoxicillin were less therapeutic than cephalosporins, cloxacillin, or amoxicillin/clavulanate (Augmentin)2. One analysis found cefuroxime (Ceftin) to be more therapeutic than erythromycin, and the probable cause for it could be the increase in&nbsp; rates of erythromycin resistance 2.

In a single study of impetigo patients, oral penicillin V was no more therapeutic than a placebo2. However, the sample size of study was small. Hence, it lacked enough statistical power to reveal a clinically meaningful difference between the treatment and placebo groups. Data comparing other oral antibacterial medicines with placebo are not available. 
&nbsp;

<h5>Topical Versus Oral Antibiotics2</h5>

Several systematic evaluations found that mupirocin was as therapeutic as numerous oral antibacterial medications such as dicloxacillin (Dynapen), cephalexin (Keflex), and ampicillin. Oral antibiotics are suggested for patients who cannot tolerate topical antibiotics and should be recommended for those with more severe or systemic infections. 
&nbsp;

Although individuals with more severe impetigo and those with systemic symptoms are frequently treated with oral antibiotics, there have been no studies comparing oral and topical medicines in this group of individuals. However, oral antibiotics can be used, according to professional advice and customary practice. Negative effects, particularly nausea, are more likely with oral antibiotics, particularly erythromycin, than with topical antibiotics. 
&nbsp;

<h5>If Your Impetigo Keeps Coming Back</h5>

A GP can examine your nose with a swab to look for the bacteria that cause impetigo.

They may recommend an antiseptic nasal cream to try to clear the bacteria and prevent the impetigo from returning.z

&nbsp;

<h5>Home Care Recommendations </h5>

Suggestions for home care are described below: 
&nbsp;

<ul>
	<li>Every eight to twelve hours, wash the sores (lesions) with an antibiotic or antiseptic soap, soaking off any visible crust.</li>
	<li>Pat the lesions dry after every wash. Each time, use a clean towel.</li>
	<li>Apply a waterproof occlusive dressing (totally cover and seal the area if possible) to prevent potential infection spread. Use a crepe bandage to keep the dressing in place or to keep younger children from scratching the sores.</li>
	<li>Consult your doctor if the sores spread and worsen despite treatment and medication, or if fever develops.</li>
	<li>While the infection is present, change the linen (towels, sheets, face washer, and sleepwear) regularly. 
	&nbsp;</li>
</ul>

<h5>Stop Impetigo from Spreading or Worsening</h5>

Impetigo can quickly spread to other sections of your body or other people until it is no longer transmissible. 
&nbsp;

Typically, it is no longer contagious:

<ul>
	<li>After you&#39;ve taken the medicines prescribed by your doctor and it&#39;s been 48 hours.</li>
	<li>When the patches become dry and crusty (if you do not get treatment). 
	&nbsp;</li>
</ul>

To help prevent impetigo from spreading or worsening, follow some dos and don&rsquo;ts:

<h5>Do&#39;s</h5>

<ul>
	<li>Avoid going to school or working.</li>
	<li>Dress loosely or cover the sores with gauze bandages.</li>
	<li>Wash your hands often.</li>
	<li>Wash flannels, linens, and towels with hot water.</li>
	<li>If your children have impetigo, wash or wipe off their toys with detergent and warm water.</li>
</ul>

<h5>Don&rsquo;ts</h5>

<ul>
	<li>Don&rsquo;t touch or scratch sores, blisters, or crusty patches; this also helps to prevent scarring.</li>
	<li>Avoid having close contact with youngsters or individuals who have diabetes or a weakened immune system (for example, if they are undergoing chemotherapy).</li>
	<li>Do not share flannels, linens or towels.</li>
	<li>Do not make food for others.</li>
	<li>Do not work out or go to the gym.</li>
	<li>Do not participate in contact sports such as football. 
	&nbsp;</li>
</ul>

The bacteria that cause impetigo can lead to other, more serious illnesses as well as harmful immunological reactions. 
&nbsp;

<h5>1. Staphylococcal Scalded Skin Syndrome</h5>

In 80% of cases, the pathogen Staphylococcus aureus causes impetigo. This bacterium induces the release of certain toxins1. These poisons can cause impetigo in the area surrounding the infection. If the toxins spread around the body, they can cause staphylococcal scalded skin syndrome(SSSS). 
&nbsp;

<h5>2. Soft Tissue Infection</h5>

The bacteria that cause impetigo can also cause other skin and soft tissue infections, such as necrotizing fasciitis. 
&nbsp;

<h5>3. Toxic Shock Syndrome</h5>

The same bacteria that cause impetigo can also cause toxic shock syndrome. Toxic shock syndrome can develop as a consequence when microorganisms enter the bloodstream. It is a potentially deadly syndrome that requires immediate medical treatment. 
&nbsp;

<h5>4. Rheumatic Fever</h5>

Group A Streptococcus is the bacteria that causes strep throat and scarlet fever, and it can also cause impetigo. Following one of these infections, your immune system may respond to inflammation, resulting in rheumatic fever.

&nbsp;Rheumatic fever is not communicable because it is an immunological reaction. However, the underlying diseases can be.

Rheumatic fever most commonly affects youngsters aged 5 to 15, but it can occur at any age. It should be treated immediately to avoid long-term consequences. 
&nbsp;

While anyone can get impetigo, the most typical risk factor is being in close touch with someone who already has the infection. Impetigo spreads more easily in enclosed areas, for example in 
&nbsp;

<ul>
	<li>Households</li>
	<li>Educational institutions</li>
	<li>Daycare centres</li>
	<li>Jails</li>
	<li>Military training institutions 
	&nbsp;</li>
</ul>

Age is another important risk factor for impetigo. The more common nonbullous form is more frequent in youngsters aged 2 to 5 years. In 90% of instances, the less common bullous form affects youngsters under the age of two4. In adults, impetigo is more frequent in men than in women4. 
&nbsp;

Having cuts and scrapes can raise your chances of getting impetigo. Be aware of activities that may cause skin breakdown and, where possible, wear proper protective equipment or clothing. Open wounds should be cleansed and bandaged. 
&nbsp;

Living in a hot or humid environment increases your chances of getting impetigo, but it can develop anywhere. 
&nbsp;

Having poor personal hygiene also raises your chances of developing impetigo. 
&nbsp;

You can lower your risk by following these steps:

<ul>
	<li>Appropriate handwashing</li>
	<li>Routine body washing</li>
	<li>Maintaining a clean face 
	&nbsp;</li>
</ul>

If the lesions cannot be reliably covered, children with impetigo should be kept at home until they are no longer infected and can spread it to others. Adults who work at offices requiring close contact should consult their medical professionals to determine when it is safe for them to return to work. 
&nbsp;

The easiest option to avoid impetigo is to maintain good hygiene. Follow these guidelines: 
&nbsp;

<ul>
	<li>Bathe and wash your hands frequently to reduce skin bacteria.</li>
	<li>To protect the region, cover any skin sores or bug bites.</li>
	<li>Keep your nails clean and trimmed.</li>
	<li>Avoid touching or scratching open sores. This can spread the infection.</li>
	<li>Wash everything that comes into contact with the lesions of impetigo in warm water and with laundry bleach.</li>
	<li>On a regular basis, change bed sheets, towels, and clothing that has come into contact with the sores until the sores have healed.</li>
	<li>Clean and disinfect any surfaces, equipment, or toys that have come into contact with impetigo.</li>
	<li>Don&#39;t share any personal goods with an impetigo patient. 
	&nbsp;</li>
</ul>
<quillbot-extension-portal></quillbot-extension-portal>

Design, Optimization and In-vivo Characterization of Mupirocin Loaded Nanostructured Lipid Carrier Based Gel for Effective Treatment of Impetigo5

Mupirocin is a broad-spectrum antibiotic that is useful in treating skin infections (such as impetigo), but its usage in standard dosage forms like pills, ointment, and cream is constrained because of its low bioavailability.

The goal of the current study was to develop, improve, and test a topical gel based on nanostructured lipid carriers (NLCs) that were loaded with the drug mupirocin (MC). 
&nbsp;

A prolonged drug profile with a significant increase in drug deposition in the skin (approximately 26%) and non-irritating qualities was shown by mupirocin (MC) loaded NLC-based gel. In conclusion, the newly created Mupirocin (MC) loaded NLC-based gel can be used as a novel method for treating impetigo by topically administering the medication with a long-lasting effect and increased patient compliance. 
&nbsp;

Key Points

<ul>
	<li>Impetigo (school sores) is a highly communicable skin condition caused by the bacteria Staphylococcus or Streptococcus.</li>
	<li>The infection is characterised by red, itchy, inflamed blisters that rupture, leak and create &lsquo;honey-colored&rsquo; crusts. Once the scab falls off, the lesion typically heals in a few days, without scarring.</li>
	<li>Antibiotic creams, ointments, syrups, and tablets are all treatment possibilities.</li>
	<li>A child with impetigo should be kept home from school or daycare centre until proper treatment has started and the sores on exposed regions are covered with a waterproof dressing, or a crepe bandage if required.</li>
	<li>Impetigo is the most frequent bacterial skin infection in children and the third most prevalent skin condition overall, after dermatitis and viral warts. 
	&nbsp;</li>
</ul>

[1] Hecht M. Everything you need to know about impetigo. Healthline.

[2] Cole C, Gazewood J. Diagnosis and treatment of impetigo. Am Fam Physician. 2007;75(6):85

[3] Bowen AC, Mahe A, Hay RJ, Andrews RM, Steer AC, Tong SYC, et al. The global epidemiology of impetigo: a systematic review of the population prevalence of impetigo and pyoderma. PLoS One. 2015;10(8):e0136789

[4] Lisa S Lewis MD. Impetigo. Practice Essentials, Background, Pathophysiology.

[5] Shinde G, Sonchhatra A, Shelke S, Pathan I. Design, optimization and in-vivo characterization of mupirocin loaded nanostructured lipid carrier based gel for effective treatment of impetigo. J Drug Deliv Sci Technol. 2022;67:102872.