Impetigo is a highly contagious bacterial skin infection that most commonly affects children, but can also affect adults. This infection usually presents as blisters or yellowish scabs on the skin, especially on the face, nose and mouth, as well as on the hands and feet. Although impetigo is usually mild and easily treated, it can cause discomfort, cosmetic concerns, and, in rare cases, complications.

What is impetigo?

Impetigo is a bacterial skin infection caused by Staphylococcus aureus or Streptococcus pyogenes bacteria. It is a superficial infection that affects the epidermis - the top layer of the skin. Infection usually begins when bacteria enter through broken skin, such as scratches, insect bites, minor burns, or areas affected by eczema. Damaged areas on the skin create a "gateway" that makes it easier for bacteria to enter. In addition, impetigo can also appear on healthy skin, where the bacteria enter through direct contact.

This infection spreads very quickly because the bacteria are easily transferred through touch, shared hygiene items or contaminated surfaces. Therefore, the infection is most often observed in collective places of children, such as schools and kindergartens, where close contacts are unavoidable. The contagiousness of this infection is so high that even small contact with contaminated surfaces or clothing can cause infection.

Manifestations of impetigo are typically associated with rapidly progressive symptoms. A few hours after the first itchy spot appears, it can turn into a painful or itchy scab. Symptoms can be aggravated by heat and humidity, as well as lack of hygiene, which create ideal conditions for the growth of bacteria. In some cases, impetigo can occur as a secondary infection to pre-existing skin lesions, such as eczema or psoriasis.

Although impetigo is mostly considered a mild infection, it can have a significant impact on a patient's well-being. Itching and cosmetic discomfort often cause anxiety, especially among children. In more severe cases, or if the infection is not treated in time, there is a chance that the bacteria will spread to deeper tissues, causing more serious consequences.

Types of impetigo

Impetigo is divided into two main types:

Uncomplicated or untreated impetigo (non-bullous impetigo)

The most common type, accounting for up to 70% of all cases. This form of the disease is mainly manifested by small, red blisters or spots that quickly turn into yellowish or honey-colored scabs. Scabs are sticky and removing them may cause some bleeding or exudate. The localization is most often around the mouth, nose and other parts of the face, but it can spread to the arms, legs and other exposed areas.

Bullas impetigo

A rarer but more severe form of the disease that usually affects infants and toddlers. It is characterized by large, fluid-filled blisters (bull), which is formed due to the toxins that are released Staphylococcus aureus. Toxins damage the interconnections between epidermal cells, causing the pits to fill with a clear or yellowish fluid.

Bullae are fragile and break easily, leaving thin, painful scabs. Affected areas may become painful, and patients often experience a low-grade fever or general fatigue. Localization is often on the neck, armpits, groin and other moist or folded skin areas.

Less common types of impetigo

Some patients are diagnosed with atypical or rarer forms of impetigo, such as combined infections with Staphylococcus aureus and Streptococcus pyogenes. In such cases, symptoms may overlap, making diagnosis more difficult. In rare cases, the infection can progress to ecthyma, a deeper form of infection that damages the dermis and causes chronic ulcers.

Prevalence and risk factors of impetigo

Impetigo is one of the most common skin infections in children between the ages of 2 and 6, but it can affect any age group, especially people with damaged skin or a weakened immune system. According to research, impetigo is a common infection in childcare facilities and schools, where there is close contact and shared hygiene items. The prevalence of infection is also high in adults who have jobs or activities involving children or high-risk groups.

Risk factors

• Skin lesions: Scratches, insect bites, burns, eczema or other skin lesions create "entry points" for bacteria that allow them to spread quickly. The smallest skin lesions, such as dry skin or small cracks, can be enough to cause an infection.
• Close contact: Family members, classmates or members of sports teams often share common items, such as towels or exercise equipment, which promotes the spread of bacteria. Due to this type of contact, the infection spreads very quickly in collective places.
• Heat and humidity: Impetigo is most common during the summer months or in tropical climates, where heat and humidity create ideal conditions for bacterial growth. For example, active physical exertion and sweating make the skin more vulnerable to infection.
• Animal contact: In rare cases, impetigo can be acquired from animals, when the bacteria enters the damaged skin through contact with contaminated animal feathers or bedding. This situation is most often observed in the countryside or in homes where pets are kept.

A broad understanding of risk factors and preventive measures can significantly reduce the spread of impetigo in both children and adults.

How to recognize impetigo?

The initial symptoms of impetigo can resemble other skin conditions, such as allergic rashes, eczema or even fungal infections. However, the infection has some characteristic features that distinguish it from other skin conditions.

Common symptoms of impetigo:

• Red spots or blisters: initially the spots appear on the skin as small, red blisters or rashes that are often itchy. These rashes can quickly progress to scabs.
• Honey or gold colored scales: one of the most pronounced symptoms is yellowish or honey-colored scabs that form on the surface of the lesion. They are often moist or sticky, and removing them may cause some bleeding.
• Itching and burning: The affected area is often itchy or has a burning sensation that prompts patients to scratch. Scratching can spread the infection to other parts of the skin.
• Swelling and redness: the skin may be slightly swollen and red. In some cases, soreness or hypersensitivity may occur.
• Bullae in impetigo: larger, fluid-filled blisters (bull) are characteristic of this form. Bullae may be clear or yellowish and rupture easily, leaving thin crusts or small areas of erosion.
• Slight fever or general malaise: In some cases, patients may experience mild systemic symptoms such as low-grade fever or fatigue.

Signs of impetigo often appear on the face, especially around the nose and mouth, but can also appear on the hands, feet, and other exposed areas of skin. The infection progresses very quickly, and therefore timely diagnosis and treatment are very important to avoid complications.

Diagnosis of impetigo in dermatology

Diagnostic methods:

• Clinical examination: a dermatologist or family doctor evaluates skin lesions, their appearance and location. Impetigo presents with honey-colored scabs, itchy patches, and red lesions that are especially visible on the face, neck, or extremities. Clinical examination allows the exclusion of other dermatological conditions.
• Differential diagnosis: impetigo can overlap with other skin conditions such as herpes infections, eczema, dermatitis or even fungal infections. Differential diagnosis is important to avoid wrong therapy and ensure correct treatment. For example, herpes simplex infection is often confused with impetigo in the early stages.
• Additional tests: In severe or recurrent cases, blood tests may be needed to assess the body's overall response to the infection or possible immunodeficiency that may contribute to the progression of the infection.

Timely and accurate diagnosis is essential to prevent the spread of infection and reduce the risk of complications. Modern diagnostic methods and assessment by an experienced specialist significantly improve the outcome of the patient's treatment.

Treatment of impetigo

Topical therapy:

• Skin cleansing: Regular washing of the affected area with warm water and a mild soap solution is important to remove scabs, bacteria and reduce the spread of infection. The washing process should be gentle so as not to damage the already inflamed skin.
• Antiseptics: In some cases, doctors recommend using antiseptic washes or solutions that reduce the bacterial load and prevent secondary infections.

Systemic therapy:

Symptomatic therapy:

• Hydration and nutrition: good hydration and a nutrient-rich diet are important for skin regeneration and overall body health. A diet rich in vitamins A, C and E, which promote skin healing, is especially recommended.

Additional measures:

• Improving hygiene: Prevention of the spread of infection is as important as treatment. It is recommended to regularly wash your hands, disinfect used surfaces and avoid sharing towels, clothing or bedding.
• Control of secondary infection: If cellulitis or a deeper tissue infection is suspected, immediate medical attention should be sought.

In general, the treatment plan includes multiple approaches that combine local and systemic therapy with symptom control and limiting the spread of infection. Early and correct treatment is a key factor in ensuring a full recovery and reducing the risk of complications.

Complications of impetigo

Although impetigo is usually a mild disease, if left untreated or not treated properly, it can lead to serious complications.

The most common complications:

• Secondary infections: bacteria can spread to deeper layers of the skin, causing cellulitis or abscesses.
• Poststreptococcal glomerulonephritis: in rare cases, streptococcal impetigo can cause inflammation of the kidneys.
• Scars: in severe cases or if the skin is scratched, permanent scarring may occur.
• Ecthyma: a rarer but more serious condition where the infection spreads to deeper layers of the skin, forming ulcers.

Prevention and control of infection

Prevention of impetigo focuses on hygienic practices and limiting the spread of infection.

Hygiene measures:

• Regular hand washing with soap and water.
• Avoiding scratching or rubbing the affected skin.
• Limiting the sharing of personal hygiene items (eg towels, toothbrushes).
• Regular washing of clothes, bed linen and towels.

Infection control:

• Children with impetigo should avoid attending school or daycare until the infection has been treated and is not contagious.
• Visitors and family members should avoid direct contact with affected areas.

Long-term effects of impetigo

Most people make a full recovery after treatment with no long-term effects. However, in severe or recurrent cases, the infection may leave aesthetic or functional consequences, such as changes in skin pigmentation or scarring.

Recurrent infections:

Recurrent impetigo is often associated with poor hygiene or immune system problems. In such cases, additional diagnostics and preventive measures are required.

Conclusions

Impetigo is a common and highly contagious skin infection that often affects children, but can also affect adults. Although the disease is usually mild and easily treated, early diagnosis and appropriate treatment are essential to prevent complications and the spread of infection.

Careful hygiene, early medical attention and preventive measures can significantly reduce the risk of impetigo spreading, improving both individual and public health. In case of severe or recurrent cases, consultation with a dermatologist is essential to adjust treatment and promote full recovery.