Impetigo Clinical knowledge summaries:-cks.library.nhs.uk/impetigo

1. ImpetigoClinical knowledge summaries:-http://cks.library.nhs.uk/impetigo

2. Impetigo • Impetigo is a common, highly contagious bacterial infection of the superficial layers of the epidermis. • It is usually due to infection with Staphylococcus aureus or Streptococcus pyogenes, alone or together It is typically classified as either primary or secondary: • Primary impetigo occurs when there is direct bacterial invasion of healthy skin. • Secondary impetigo occurs when infection is secondary to some other underlying skin disease (particularly eczema, scabies) or trauma that disrupts the skin barrier

3. CKS Impetigo Guidance – Diagnosis • Impetigo causes characteristic, yellow, crusted lesions. • The lesions are most commonly found on the face. • Typically there are also scattered surrounding lesions, known as ‘satellite’ lesions. • Under the crusts the base of the lesion is red, but there is no surrounding erythema. • The person is rarely systemically unwell and the lesions are usually painless. • There may be a history of contact with a person with impetigo (e.g. at school, in the family)

4. Typical appearance of impetigo in a child

5. Typical appearance of impetigo in a child

6. CKS Impetigo Guidance – How common is it? • Impetigo is the most common skin infection in children. • The incidence in general practice has been reported at 2.8% of all children aged 4 years and under, and 1.6 % of all children aged between 5 and 15 years. • Peak incidence occurs between the ages of 2 and 6 years • In adults, infections in men predominate and large outbreaks may be seen in confined environments such as barracks.

7. CKS Impetigo Guidance – How should it be treated? • Oral flucloxacillin for 7 days is the first choice oral antibiotic. • Optimum length of treatment unknown, but 7 days considered reasonable (PHLS) • Erythromycin is an alternative oral antibiotic if the patient is allergic to penicillins (Not included in the nurse prescriber ‘Extended Formulary’).Note local guidelines recommend clarithromycin. • For a small, localized patch of impetigo, topical fusidic acid applied three times a day for 5 days is an alternative to an oral antibiotic.

8. CKS Impetigo Guidance • Should crusts be removed? • It is commonly recommended that crusting skin lesions or exudates be softened, and removed if possible, by soaking in warm water or povidone-iodine prior to applying ointments. • What advice on avoiding spread? • Wash your hands after touching a patch of impetigo, and after applying antibiotic cream. • Do not share towels, flannels, etc, until the infection has gone. • Children with impetigo should stay off school or nursery until there is no further crusting.

9. CKS Impetigo Guidance – What if the treatment is not effective? • Check compliance with prescribed medication. Refer to GP GP advised to:- • Swab to exclude other infections or resistant organisms. • Rarely, streptococcus can secondarily infect lesions, and this should be suspected if treatment fails. • If symptoms worsen, prescribe phenoxymethylpenicillin while awaiting test results. • Do not use repeated courses of a topical antibiotic. • Consider underlying disorders e.g. scabies.

10. CKS Impetigo Guidance – Patient discussion points? • Impetigo is not usually serious, but can spread if not treated. • An antibiotic cream may be used for a small patch of impetigo. • Antibiotic liquid, tablets or capsules are used if the infection is more widespread. • Impetigo is contagious: • Try not to touch patches of impetigo. • Wash your hands if you do touch a patch of impetigo, and after applying antibiotic cream. • Do not share towels, flannels, etc, until the infection has gone. • Change towels frequently to stop spread of infection. • Children with impetigo should stay off school or nursery until there is no further crusting.