Symptoms and Types of Impetigo

Impetigo is a common and highly contagious bacterial skin infection characterized primarily by blisters that rupture to form golden crusts. Although it is generally a superficial infection, there is also a deeper variant known as necrotizing impetigo, which can lead to ulcers and more extensive tissue damage. While impetigo is most frequently seen in young children, individuals of any age can be affected.

Transmission channels of Impetigo

Impetigo is mainly caused by Staphylococcus aureus and, less commonly, by Group A Streptococcus. Staphylococcus aureus secretes various toxins that disrupt the protective barrier of the skin, leading to the formation of blisters. When these blisters rupture, they leave behind the classic golden crusts. Based on clinical presentation, impetigo can be roughly divided into two types:

• Bullous Impetigo: Characterized by large blisters and significant skin swelling. Once these bullae rupture, they quickly form a crusting layer.
• Non-bullous Impetigo: Typically begins as red, inflamed papules that evolve into small pustules and eventually crust over.

Necrotizing impetigo is a rarer and more severe form of the infection. It affects deeper layers of the skin, causing tissue necrosis and ulceration, and usually requires more aggressive treatment and close medical monitoring.

Transmission and Contagiousness
Impetigo spreads very easily, primarily through:

• Direct Contact: Touching the infected area, especially when children scratch or touch the lesions and then inadvertently spread the bacteria to other parts of their body.
• Indirect Contact: Sharing items such as towels, clothing, or bed linens that have been in contact with an infected person can also serve as a vehicle for transmission.

Generally, individuals remain contagious until the lesions have healed or until 48 hours after starting antibiotic treatment. Therefore, children with impetigo should be kept out of daycare or school until they are no longer infectious.

Treatment and Management
The management of impetigo focuses on proper wound care, prevention of further spread, and the use of appropriate antibiotics:

• Daily Hygiene: Gently cleaning the affected skin daily using water and a mild soap to remove crusts is essential. Keeping the area dry and using waterproof dressings to cover lesions can help prevent the spread of infection.
• Topical Antibiotic Therapy: For milder infections, physicians typically prescribe topical antibiotic ointments, such as mupirocin ointment or fusidic acid cream. After cleaning the skin and removing crusts, applying the ointment for several consecutive days is often effective in controlling the local infection, with minimal side effects compared to oral antibiotics.
• Oral Antibiotic Therapy: In more severe cases—such as when widespread involvement with numerous blisters is observed—oral antibiotics become necessary. Common choices include amoxicillin-clavulanic acid and cephalexin, with the specific regimen typically determined by bacterial cultures and sensitivity tests.

Prevention and Precautions
Preventing the spread of impetigo relies principally on good personal and environmental hygiene:

• Frequently washing hands and avoiding the sharing of towels, clothing, and other personal items.
• Promptly cleaning and covering infected areas to prevent further spread via scratching.
• Regularly cleaning households, schools, and daycare centers to reduce opportunities for bacterial proliferation.

In summary, impetigo is a common bacterial skin infection that, with timely and appropriate local care and targeted antibiotic therapy, generally yields a favorable outcome within a short period. For children with impetigo, in addition to treatment, it is crucial for caregivers and healthcare providers to work on preventing cross-infection and recurrences to ensure both individual and public health safety.