Impetigo is an itchy and sometimes painful infection of the outer layers of skin that is especially common in young children. It is caused by bacteria and is highly contagious. For that reason, children who have impetigo are not allowed to return to school or day care until they are no longer contagious – about 24 hours after the start of treatment with antibiotics. Without treatment, it can remain contagious for several weeks.
The first signs of impetigo are usually visible around the mouth and nose in the form of an itchy reddish rash with liquid-filled blisters that burst easily. The burst blisters form yellowish crusts, which then later fall off without scarring.
Causes and risk factors
Impetigo is a bacterial infection, usually caused by Streptococcus or Staphylococcus bacteria. These germs can enter your skin in different ways, including through minor cuts or scrapes, a rash or an insect bite.
They spread to other people through skin contact, or through contact with objects that an infected person has touched.
Prevalence and outlook
The typical rash appears a few days after infection, which can spread to your hands, arms or legs. In rare cases it may also spread to deeper skin layers or under your fingernails. Impetigo usually clears up on its own, but that can take a few weeks. Unfortunately, having impetigo doesn't make you immune to the bacteria, so you don't have any protection against further infection.
Antibiotic creams have proven effective. Antibiotics that are swallowed (oral antibiotics) are usually only prescribed if a child has impetigo on a large area of skin or if several parts of their body are affected. Antibiotic tablets are more likely to have side effects than antibiotic creams. For instance, they may cause gastrointestinal (stomach and bowel) problems.
Good hygiene is the key to avoiding infection, especially
- washing hands frequently,
- not sharing towels, and
- washing worn clothing at 60°C (140°F) or higher.
It's a good idea to keep the child’s fingernails trimmed very short so they can't scratch themselves as much.
Impetigo is one of the diseases covered by the German Protection against Infection Act (Infektionsschutzgesetz). This means that, under German law, someone who is suspected of having the condition must stay away from community facilities where they would come into contact with others. Only once a doctor has decided that the child is no longer contagious is it possible to return. This is typically 24 hours after the start of treatment with antibiotics, or after the impetigo has cleared up on its own.
Bundesministerium der Justiz und für Verbraucherschutz. Gesetz zur Verhütung und Bekämpfung von Infektionskrankheiten beim Menschen (Infektionsschutzgesetz - IfSG). § 34 Gesundheitliche Anforderungen, Mitwirkungspflichten, Aufgaben des Gesundheitsamtes.
Koning S, van der Sande R, Verhagen AP, van Suijlekom-Smit LW, Morris AD, Butler CC et al. Interventions for impetigo. Cochrane Database Syst Rev 2012; (1): CD003261.
Robert Koch-Institut (RKI). Gemeinsam vor Infektionen schützen. Belehrung für Eltern und sonstige Sorgeberechtigte durch Gemeinschaftseinrichtungen gemäß § 34 Abs. 5 Satz 2 Infektionsschutzgesetz. January 22, 2014.
Schöfer H, Bruns R, Effendy I, Hartmann M, Jappe U, Plettenberg A et al. S2k + IDA Leitlinie: Diagnostik und Therapie Staphylococcus aureus bedingter Infektionen der Haut und Schleimhäute. AWMF-Registernr.: 013-083. April 2011.
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