Impetigo

I have been getting a lot of calls lately from concerned parents who have gotten a notice from school or daycare that their child has been exposed to impetigo.

Our world is full of bacteria. There are beneficial ones and dangerous ones.

We are constantly surrounded by potentially harmful bacteria that seem to have the "if you don't bother me, I won't bother you attitude". Many folks, without being aware of it, are carriers and routinely  have bacteria such as staph on their skin.

Our skin is our all important protective barrier. Bacteria that is not causing any trouble as long as it remains on the outside of the body can wreak havoc if it makes it's way in. When there is a break in the skin from a cut, bite, or an itchy rash that has been scratched, the bacteria can take advantage of that, enter the body and cause an infection.

Impetigo is one of the most common skin infections out there.

It is usually caused by either Staph or Strep. By far, most of the time Staph is the culprit

There are two types of impetigo.

Bullous impetigo is less common and usually shows up in much younger children. This is characterized by large pus filled blisters.

More common is the non-bullous impetigo, this will have crusty, rashy areas that may have a honey colored glaze. Most of the time you will see these lesions around the mouth and the nose.

This also often affects the diaper area, but  can show up anywhere, more often on exposed parts of the body.

These spots and rashy areas can spread. They don't seem terribly painful and most of the time your child might seem quite well. The spots simply may flare up on and off  but usually don't  clear up completely without treatment.  

(super red/open rashy areas around the butt might be strep. We can do a test for that in the office) 

Young children and school age children are the most common victims of Impetigo, likely because they tend to come into more 'close contact' situations with others.

It is easily spread from direct touching with an infected person,or from coming into contact with contaminated surfaces like toys.

The incubation period is 1-3 days.

If you are dealing with  a very small area, the standard treatment  is an antibiotic ointment. With a really mild infection over-the- counter Neosporin may take care of it. If you don't notice an obvious improvement within 48 hours you may need to be seen or talk to your doctor about getting a prescription ointment called Mupirocin (Bactroban is the trade name).

Some cases are severe enough to warrant a course of oral antibiotics. In our office we will almost always want an office visit to help make that determination.

If a family member has been diagnosed, wash any sheets, towels, toys etc

To prevent getting this in the first place, good hand washing is key.

Do your best to keep skin safe and intact. Dry, itchy skin is more at risk because of the tendency to scratch. Eczema seems to easily  get infected areas. Keeping the skin well moisturized can help. Calendula cream is thought by some to have a natural antibacterial property.

Keep nails short to avoid damaging scratching.

To prevent infection, any mild cut or open lesion should be kept covered  with an antibiotic ointment applied 2 or 3 times per day.  

If your child has a case of impetigo or has been exposed you may also want to put a thin film of Neosporin or Mupirocin  under the fingernails and inside the each nostril twice a day to prevent spreading. Dr Schwanke is a big advocate of getting the ointment inside of the nose since that is often the source of the bacteria.

Another thing to consider is a bleach bath. "What?" you say.

I know, the first time I learned about this I was fairly dubious, but it is currently a strong recommendation from many dermatologists.

Adding ¼ cup of basic bleach to a standard tub can be useful for preventing and treating a multitude of skin afflictions. This will kill any staph or bacteria that is hanging out on the skin. It turns out that it is usually not at all irritating and has very few adverse effects.

I just learned another fact that knocked my socks off. A recent study claims that at least 30% of our tubes of various ointments are contaminated with bacteria. It doesn't take much thought to figure out how that would happen. We touch the tube tip with our unwashed fingers, or we touch the tube to the surface of our skin.

Do me a favor, from now on, try to keep any new tube sterile. Squeeze the dose of ointment or cream onto an applicator (you can use a spoon) and avoid having any direct contact with the tip or rim.

Okay, to sum it up.

If you are one of the families who got the Impetigo warning....

Hopefully your school setting has done it's job and has thoroughly cleaned toys, surfaces etc.

Aside from that, checking your child to make sure they have no spots anywhere is the only action plan that I would advise.

If they have any questionable spots, treat as discussed.

As I mentioned in my recent post about contagiousness, A notice about impetigo exposure would not be a reason to keep them home from school.

Chances are, unless you have been out of day care for an extended period,  they have already been exposed.