“Kids get it by being around each other, kind of rubbing up against each other,” says Suzanne Friedler, MD, a board-certified fellow of the American Academy of Dermatology and a clinical instructor at Mount Sinai Hospital’s Icahn School of Medicine in New York City. Just because it’s most commonly found among children, though, doesn’t mean adults are immune to it. They can still contract it — usually by catching it from their children — but the treatment is the same, says Vikash S. Oza, MD, a pediatric dermatologist at NYU Langone Health in New York City. Impetigo is contagious and is passed through direct physical contact. (2) But just because your child touches another child with impetigo doesn’t mean he or she will definitely get it. It depends on how healthy the skin is. If the skin’s perfectly healthy, he or she should be in the clear and able to avoid becoming infected. But if the skin is compromised in some way, whether through a scrape or a bug bite or an eczema flare-up, the risk of developing impetigo increases. “Skin conditions, such as eczema, dryness, or anything that weakens the skin, can cause kids to be more susceptible to impetigo,” says Lisa Denike, MD, a pediatrician with Kaiser Permanente based in Vancouver, Washington. “Weakened skin allows bacteria to more easily enter and cause an infection.” There are two types of impetigo:
Nonbullous impetigo, which accounts for 70 percent of cases, is caused by bacteria called Staphylococcus aureus, which causes staph infection, or Streptococcus pyogenes, which can also cause strep throat. With this type, impetigo presents itself as a honey-colored, crusty rash on the face and other parts of the body. Often, nonbullous impetigo will appear around (but not inside) the mouths of children, Dr. Oza says.Bullous, the less-common type of impetigo in adults, is caused strictly by Staphylococcus aureus. With this strain, you will likely see blisters in areas where skin rubs together on the body, such as the armpit. (2)
The good news is that both types of impetigo are easily treated. The key is to treat it early. “You have an infection on your skin and if you don’t treat it, it can continue to worsen,” Oza says. “It’s something that you want to take care of.” You also want to treat any underlying skin conditions — and quickly. For instance, “if somebody has eczema, you definitely want to treat that eczema because the broken-down skin barrier allows bacteria to penetrate very easily,” Friedler says. Once you start to see the crusty, honey-colored bumps, chances are it’s turned into impetigo. Oftentimes it’ll start as red bumps that ooze before turning into crusty scabs. It could be one or two sores, or it could be several grouped together in a certain area, Oza says. Technically, impetigo should clear up on its own within a few weeks if it’s regularly cleaned with soap and water. (2,3) “But considering that it can be uncomfortable and highly contagious, we recommend treatment by a doctor,” Dr. Denike says. Treatment can help the impetigo clear up within 10 days and limit the chances of it spreading. (2) “If you’re having it present for a couple of days, you should see a provider about the infection, and it should be appropriately treated,” Oza says. Instead, a doctor will likely recommend a topical antibiotic, such as ozenoxacin (Xepi), mupirocin (Bactroban), retapamulin (Altabax), or fusidic acid. (1) It should be applied directly to the sores on the body. Your doctor might suggest soaking the scab first so the antibiotic can really get down into the skin. (4) The goal is to keep the impetigo contained and prevent it from spreading to other parts of the body and to other family members in the household. That’s where good hygiene comes into play. Be diligent about thoroughly cleaning towels and sheets, for instance, to reduce the risk of impetigo spreading, Oza says. Set the washer to hot water, and dry the laundry on high heat to kill as many germs as possible. (5) “Also, as is the case with most illnesses, washing your hands is key to prevention,” Denike says. Maintaining short, trimmed fingernails is another way to keep impetigo from spreading. Children with eczema (or atopic dermatitis) are more prone to developing impetigo because of the itch-scratch-itch cycle that is common in this skin condition. Often, if a child scratches the infected area, the bacteria can get into the fingernails and then spread easily when he or she touches other people or other parts of the body. In general, a mild case of impetigo isn’t much to worry about, and it’ll usually go away two to five days after starting treatment, Denike says. “It’s usually a small, localized infection in a small area, and it’s very easily treated with a topical antibiotic,” Oza says. There are some reports that home-based remedies, such as tea tree oil, coconut oil, and Manuka honey, also work to treat impetigo. (1) But evidence backing them up is weak, and Oza cautions not to rely on them. “If it’s truly impetigo, that means it’s a bacterial infection in the skin, and you need to use an antibiotic to treat the bacteria,” he says. “We don’t have any data to support natural-based oils being an effective agent to kill bacteria and therefore treat the infection.” Even if the infection clears up before then, you’ll want to take all of the antibiotics the doctor prescribed to reduce the chances of it coming back. (5) Finishing all of the medication can also can keep you from becoming resistant to the antibiotics. (4) Among the options for oral antibiotics are: (1)
amoxicillin and clavulanate (Augmentin)dicloxacillin (Dycill) cephalexin (Keflex)clindamycin (Cleocin)doxycycline (Vibramycin)minocycline (Minocin)trimethoprim and sulfamethoxazole (Bactrim)macrolides, such as clarithromycin (Biaxin) and erythromycin (MY-E)
Be sure to ask your doctor about potential side effects, because some oral antibiotics can cause stomach problems. (6) If a child is getting impetigo over and over again, Friedler suspects he or she could be harboring bacteria in the nose or anus. “Sometimes we’ll treat those children for a week with Bactroban inside the nose and in the inner anal area,” she says. For these patients, she also recommends a bleach bath. “It’s a very diluted bath using about a half tub of water and ¼ cup of bleach,” she says. “That makes the water sort of like a swimming pool, so it’s not very strong, but enough to fight the bacteria on their skin.” She also recommends antibacterial washes, like CLn BodyWash and Cetaphil. Older children who contract impetigo, such as those on the wrestling team or who engage in another high-contact sport, may benefit from using a peroxide wash. “I’ll have them use that regularly and that will decrease the amount of bacteria on their skin,” Friedler says. These washes can treat an already existing infection and can be used as a preventative measure, too. If you follow these treatment methods and the impetigo doesn’t go away or — worse — it continues to spread or is accompanied by swelling, pain, or a fever, it’s time to visit the doctor again. (3) Friedler says this advice applies to young children who attend day care or preschool. “If it’s an older child that’s in grade school, they’re not really contacting other kids as much, so it’s not an issue,” she says. “It’s more that skin-to-skin contact that you want to avoid for younger children.” The older children likely don’t need to miss any school at all. Oza says so long as the impetigo is in a small area and is currently being treated, it’s okay to keep your child involved in his or her usual day-to-day activities.
