Impetigo

Abstract

Impetigo is a contagious, superficial bacterial infection of the skin. Over 140 million people are suffering from impetigo, globally at any given time. Impetigo is the most common skin infection in children aged two to five, but it can occur at any age. The incidence decreases with growing older. Infection generally occurs in warm, humid conditions, and risk factors include poor hygiene, poverty, and scabies. There are two clinical forms of impetigo: non-bullous and bullous. Non-bullous impetigo is more common form. It usually occurs on the face, predominantly on the nose or the extremities after trauma. The change begins as an erythematous macula that rapidly evolves into a vesicle or pustule. After the vesicle or pustule ruptures, erosion occurs, covered with a honey-colored crust on an erythematous basis. The causative agents of non-bullous impetigo are Staphylococcus aureus and Streptococcus pyogenes. Bullous impetigo mostly occurs in newborns and children aged 2 to 5 years. It is characterized by the appearance of a flabby bulla, initially filled with serous contents, which burst easily and erosions are formed covered with brownish-yellow crusts. The changes most often occur on the trunk, extremities and wet intertriginous areas. Bullous impetigo is exclusively caused by strains of Staphylococcus aureus. Skin lesions, which occur in patients with impetigo, should be kept clean, washed with soap and warm water, and secretions and crusts removed. The use of systemic antimicrobial agents is indicated when they are affected by an infection of a deeper structure (subcutaneous tissue, muscle fascia). The use of systemic antibiotics is also indicated if fever, lymphadenopathy, pharyngitis, infections near the oral cavity, scalp infections and/or multiple lesions occur. The use of topical antibiotics in the treatment of localized impetigo has shown high efficacy. The advantages of using topical antibiotics are that they minimize the development of antibiotic resistance and avoid gastrointestinal and other systemic side effects. The duration of local treatment varies depending on the product itself, but clinical trials have shown that the duration of therapy of seven days is effective. Potential disadvantages of topical antibiotics include local allergic reactions, skin hypersensitivity, and difficulty applying to parts of the body such as the eyelids, lips and back. There are a number of topical antibiotics used to treat impetigo. The most commonly used today are mupirocin, fusidic acid, neomycin, bacitracyn, retapamulin and gentamicyn sulfate. Patients should be educated about the mode of transmission, clinical course, hygiene and precautions in case of infection. It is especially important to emphasize the need of hygienic measures in order to prevent the spread of infection. These measures include washing hands, cleaning minor injuries with soap and water, bathing regularly and avoiding close contact with infected people.