Impetigo is a contagious skin infection that causes small, pus-filled sores with hard, golden or honey-colored scabs. These sores usually develop around the lips and nose.

This infection is more common in children, but can occur at any age. It can also affect other parts of the body such as the arms, legs or feet. Impetigo is transmitted through contact with the pus released by the lesions, therefore patients who have started treatment are advised to isolate for at least 2 days.

Signs or symptoms that may indicate impetigo should be assessed by a dermatologist or pediatrician. If confirmed, the doctor can prescribe antibiotic ointments to promote healing.

Imagem ilustrativa número 1 — Impetigo não-bolhoso

Common symptoms

Impetigo symptoms may vary depending on the type of impetigo:

1. Common impetigo (non-bullous)

The symptoms of common impetigo are small lesions and/or sores around the nose and mouth, which can develop into yellow or brown scabs.

2. Bullous impetigo

The main symptoms of bullous impetigo are:

Red sores on the skin and lesions that quickly develop into blisters
Blisters on the arms, legs, chest and belly
Itchy and red skin around the blisters
Yellow scabs
Fever above 38ºC (or 100.4ºF)
General malaise
Lack of appetite

3. Ecthyma

The symptoms of ecthyma are usually a little more severe, since it affects the deeper layers of the skin. With this condition, it is more common to see open wounds with pus and large, yellow scabs and redness.

How do you get impetigo?

Impetigo is caused by bacteria that is naturally present in the skin, such as Streptococcus pyogenes or Staphylococcus aureus. These normally do not cause any symptoms, but changes in immunity can lead to overgrowth of the bacteria which can spread to deeper layers of the skin. This condition is even more likely to develop if a wound is already present in the skin.

Given impetigo is more common in those with a compromised immune system, it is more common to be seen in children, the elderly and people with autoimmune disorders.

Treatment options

Treatment for impetigo should be guided by pediatrician for children or a dermatologist in adults. This condition is usually treated with an antibiotic ointment, applied 3 to 4 times a day for 5 to 7 days. It is important for treatment to begin as soon as possible to prevent the bacteria from reaching deeper layers of the skin, which can lead to further complications.

Small scabs on the skin can be gently removed with soap and warm water. However, larger wounds with scabs, measuring more than 5 mm in diameter, should not be removed. Instead, the doctor will likely advise a moisturizing lotion to soften the crust and promote skin healing before the scab falls off.

Impetigo is contagious and therefore people with confirmed cases should remain in isolation. All clothing, towels, sheets and personal objects should be washed thoroughly to prevent the disease from being passed on to other people.

Medication for impetigo

The medicine that the doctor may prescribe for impetigo includes:

Antiseptic lotion, such as Merthiolate, for example, to eliminate other microorganisms that may be present and lead to further complications;
Antibiotic ointments such as Neomycin, Mupirocin, Gentamicin, Retapamulin, Cicatrene, or Nebacetin, for example;
Amoxicillin + Clavulanate, which can be used in babies and children when there are many lesions or signs of complications;
Long-acting antibiotics, such as Erythromycin or Cephalexin, when there are many lesions on the skin.

In addition, the doctor may recommend applying saline solution to soften the wounds, increasing the effectiveness of the ointment. The treatment lasts between 7 and 10 days, and even if the skin wounds disappear sooner, it is necessary to continue the treatment for all the days indicated by the doctor.

Prevention measures

To avoid getting impetigo again, you should adhere to the treatment prescribed by the doctor until the wounds are completely healed. Keeping your nails short can also help to prevent worsening, as this can prevent the entry of bacteria into the deeper layers of the skin from scratching.

During treatment, it is also very important to take certain precautions, such as:

Irrigating your nose with saline solution to clear out any bacteria
Avoiding sharing sheets, towels or other objects that are in contact with the affected area;
Keeping wounds covered with clean gauze or clothing;
Avoiding touching or picking at wounds, lesions or scabs;
Washing your hands frequently, especially before coming into contact with other people;

In the case of babies and children, it is very important to only let them play with washable toys, as they must be washed 48 hours after starting treatment to prevent the infection from returning, as bacteria can remain on the surface of the toys.

If left untreated or not treated as prescribed by the doctor, impetigo can lead to complications such as infectious cellulitis, osteomyelitis, septic arthritis, pneumonia, glomerulonephritis or septicemia, especially in people with a compromised immune system.