Clinical Reference Systems: Pediatric Advisor 10.0
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DESCRIPTION

• Sores are less than 1 inch in diameter.
• Sores begin as small red bumps, which rapidly change to cloudy blisters, then pimples, and finally sores.
• Sores increase in size (any wound that doesn't heal).
• Sores are often covered by a soft, yellow-brown scab.
• Scabs may be draining pus.
• Impetigo often spreads and the sores increase in number from scratching and picking at the initial sore.
• Any wound that doesn't heal, or a wound that increases in size, usually has become infected.

CAUSE

Impetigo is a superficial infection of the skin, caused by Streptococcus bacteria or Staphylococcus bacteria. It is more common in the summertime when the skin is often broken by cuts, scrapes, and insect bites. When caused by a strep infection of the nose, the impetigo usually first appears near the nose or mouth.

EXPECTED COURSE

With proper treatment, the skin will be completely healed in 1 week. Some blemishes will remain for 6 to 12 months, but scars are unusual unless your child repeatedly picks his sores.

HOME TREATMENT

1. Oral antibiotic

   Most children with impetigo need an oral antibiotic prescribed by their physician.

   One or two sores that develop after an insect bite or cut may need only an antibiotic ointment.

2. Antibiotic ointment

   Before you first apply the antibiotic ointment, remove the scab. Apply the antibiotic ointment to the raw surface three times a day. You don't need a prescription for the ointment. Cover the sores with a Band-Aid to prevent scratching and spread. Apply the ointment for 7 days, or longer if necessary. The area should be washed off with an antibacterial soap each time before you apply the ointment. Any new crust that forms should not be removed because this delays healing.

3. Removing the scabs

   The bacteria live underneath the soft scabs, and until these are removed, the antibiotic ointment has difficulty getting through to the bacteria to kill them. Scabs can be soaked off using warm water and a liquid antibacterial soap. The area may need to be gently rubbed, but it should not be scrubbed. A little bleeding is common if you remove all the crust.

4. Preventing the spread of impetigo to other areas on your child's body

   Every time your child touches the impetigo and then scratches another part of the skin with that finger, he can start a new site of impetigo. To prevent this, encourage your child not to touch or pick at the sores. Keep his fingernails cut short, and wash his hands often with one of the antibacterial soaps.

5. Contagiousness to others

   Impetigo is quite contagious. Be certain that other people in the family do not use your child's towel or washcloth. Your child should be kept out of school until he has been on treatment for 24 hours with oral antibiotics or 48 hours with antibiotic ointment alone. For mild impetigo treated with an antibiotic ointment, the child can continue to attend day care or school if the sore is covered with a Band-Aid.

CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:

• Your child starts to act very sick.

CALL YOUR CHILD'S PHYSICIAN WITHIN 24 HOURS IF:

• The size and number of sores increase after 48 hours of treatment.
• A fever or a sore throat occurs.
• The impetigo is not completely healed in 1 week.
• You have other questions or concerns.