Pediatric Impetigo

Impetigo is a skin infection. When it affects just the surface, it’s called superficial impetigo. Impetigo can also affect deeper parts of the skin. This is called ecthyma. It may occur on healthy skin. Or it may occur where the skin was injured by a cut, scrape, or insect bite.

Impetigo is most common in children from ages 2 to 5. It is contagious. This means it’s easily passed from one person to another. It can be spread around a household. Children can infect other family members, and can reinfect themselves.

Impetigo is caused by bacteria. The bacteria that can cause it include:

• Group A beta-hemolytic Streptococcus
• Staphylococcus aureus

Impetigo is more common in children, but adults may also have the infection. A child is more likely to get impetigo if they:

• Have close contact with to others with impetigo
• Don't keep clean (poor hygiene)
• Are in warm, moist (humid) air
• Have other skin conditions, such as scabies or eczema

Symptoms can occur a bit differently in each child. They also vary depending on which bacteria caused it. Symptoms can include:

• Red bumps
• Sores that are filled with fluid, draining fluid, or crusted over (this often results in the classic "honey-colored crust" appearance)
• Areas that are red, swollen and may itch
• Swelling of nearby lymph glands (nodes)

The bumps or sores can be painful and appear anywhere on the body. But they are most common on the face, arms and legs.

The symptoms of impetigo can be like other health conditions. Make sure your child sees their healthcare provider for a diagnosis.

The healthcare provider will ask about your child’s symptoms and health history. They will give your child a physical exam. A sample of the pus from the sores may be sent to a lab. This is called a culture. It’s done to see what type of bacteria caused the infection. It can help the doctor decide the best antibiotic for treatment.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may include:

• Prescription antibiotic cream or ointment. This is most often done for mild impetigo. Over-the-counter antibiotic cream or ointment is often not advised.
• Antibiotic pills or liquid by mouth (oral). This is most often advised if your child has several areas of impetigo or ecthyma. It may also be advised if more than one person in a household has impetigo.
• Cleaning and bandaging. You will need to gently wash affected areas of your child’s skin with mild soap and water. Cover areas that are draining fluid. Make sure to scrub your hands for at least 20 seconds before and after caring for your child’s impetigo. Put old bandages in a sealed bag and throw them away.

Possible complications of impetigo can include:

• Worsening or spreading of the infection
• Scarring, which is more common with ecthyma

Impetigo caused by beta-hemolytic strep bacteria can cause:

• Kidney damage (poststreptococcal glomerulonephritis)
• Fever, joint and other problems (rheumatic fever)

You can help to prevent impetigo and prevent it from spreading to others. The following may help:

• Keep your child out of daycare or school for 48 hours after starting antibiotic treatment. If your child is improving with treatment, they can return after 48 hours. Cover any draining sores with bandages.
• Make sure your child and everyone else in your household washes their hands often and well. This means using soap and water and scrubbing for at least 20 seconds.
• Don't share personal items such as towels or washcloths.
• Have everyone in the household use their own towels for drying hands and for after bathing. Don't share towels.
• Keep your child's fingernails short. This can help prevent your child scratching and spreading the infection.
• Teach everyone in the family when and how to correctly wash their hands.

If your child is being treated for impetigo, contact your provider if their symptoms don't improve or get worse. Call the healthcare provider if your child has a skin infection after being in contact with anyone who has impetigo. Keep your child away from others until a diagnosis has been made.