What are The Possible Complications of Impetigo and How Can You Help Prevent Them?
â€œIt can be an insect bite, then a secondary bacterial invasion â€” impetigo â€” and hopefully nothing further because we will not let it go any deeper,â€ says Charles Shubin, MD, a pediatrician with Mercy Family Care Physicians in Baltimore.
Treatment of impetigo is swift if a parent notices signs of the infection â€” such as red sores on the childâ€™s nose, mouth, hands, or feet â€” and seeks help from a healthcare provider. â€œUsually impetigo will appear with honey-colored substances on the skin,â€ says Vikash S. Oza, MD, a pediatric dermatologist at NYU Langone Health in New York City. â€œTheyâ€™ll start as very tiny superficial sores or tiny bumps that form a particular crust right on top of it.â€ The honey-colored crusts take the place of the sores once they burst. (1)
Dr. Shubin says impetigo is extremely common among children, especially in warmer months. â€œTheyâ€™re outside, theyâ€™re getting dirtier, theyâ€™re doing things they wouldnâ€™t do inside,â€ he says. They also may be getting more bug bites or scrapes in the summer, which can increase the risk of developing impetigo.
Diagnosing Impetigo: What to Expect if You See Your Primary Care Doctor or Dermatologist
Healthcare providers normally can identify impetigo simply by looking at the infection because it has such distinctive characteristics. But because doctors normally diagnose simply based on appearance, misdiagnoses can occur, too.
Shubin admits impetigo is a bit misunderstood. â€œImpetigo is a bacterial infection of the skin,â€ he says. â€œThat sounds pretty straightforward, but there are things that look like impetigo that arenâ€™t.â€ A doctor may also diagnose something as impetigo when really itâ€™s something else. â€œThere are things that mimic it, and thatâ€™s why you may want to see a provider for a diagnosis,â€ Dr. Oza says.
Impetigo is sometimes mistaken for:
Herpes â€œFever blisters look like they could be impetigo in many cases, and when they burst, they crust, and crusting is a very common presentation of impetigo,â€ Shubin says.
Shingles Shingles occurs more often in adults than children, and itâ€™s accompanied by something impetigo normally is not: pain. â€œShingles really hurts because itâ€™s in the nerve,â€ Shubin says. â€œImpetigo, on the other hand, is quite superficial, and if it gets deep one could argue it shouldnâ€™t be called impetigo.â€ Impetigo can sometimes be itchy, but itâ€™s not usually painful. (2)
Hand-Foot-and-Mouth Disease Normally, the dead giveaway that itâ€™s hand-foot- and-mouth disease and not impetigo is the appearance of sores inside the mouth. â€œImpetigo by definition is a skin infection,â€ Shubin says. â€œThere is no skin in the mouth, so if itâ€™s in the mouth, itâ€™s not impetigo.â€
That sounds simple enough, but itâ€™s complicated by the fact that the current strain of hand-foot-and-mouth disease in the United States results in lesions forming around the mouth and not just inside the mouth, Oza says.
So how can you tell them apart? With hand-foot-and-mouth disease, â€œyou should get a widespread rash where you have red spots on the palms and soles and occasionally elsewhere on the arms and legs,â€ Oza says. Itâ€™s also usually accompanied by other symptoms, including fever, sore throat, and loss of appetite. (3)
Is It Shingles or Something Else?
Shingles and impetigo share similar characteristics, and the same goes for shingles and a number of other skin conditions. Find out exactly what shingles looks like here.
Treating Impetigo: What Your Healthcare Provider May Recommend
â€œThere are two bacteria that cause impetigo: staph and strep,â€ Shubin says. Streptococcus (which causes strep throat) thankfully responds to antibiotics, but staphylococcus (which causes staph infection) has â€œbecome increasingly resistant to anything we have,â€ he says.
Shubin says he normally will prescribe Keflex (cephalexin) for impetigo to treat both strains of bacteria simultaneously. Another reason he frequently prescribes it: â€œIt's delicious,â€ he says. â€œThat really matters. You want a kid to take medicine for 10 days, it better be quite acceptable.â€
Once treatment begins, the infection will likely go away within a few days, though itâ€™s important to completely finish the antibiotics prescribed by the doctor to keep the infection from appearing again.
What Complications Can Arise if Impetigo Is Left Untreated?
Impetigo isnâ€™t usually anything to worry about when you treat it. Even scarring isnâ€™t much of a concern, unless the child scratches a lot, says Suzanne Friedler, MD, a board-certified fellow of the American Academy of Dermatology and a clinical instructor at Mount Sinai Medical Center in New York City.
Spreading the Infection to Others
This is the biggest thing to worry about when it comes to impetigo. â€œThe most obvious complication is it will continue to spread to other areas, and youâ€™ll see crusting and sores on the skin,â€ Oza says.
To minimize the chances of spreading to other parts of the body, Shubin suggests parents take measures to keep kids from harboring bacteria under their fingernails. Impetigo doesnâ€™t usually itch too much, but it can be uncomfortable and kids may pick at the infected sores. (1) â€œAs we used to do with chicken pox, weâ€™d tell people to trim their childâ€™s nails,â€ he says. â€œIf theyâ€™re still scratching, put socks on the hands so theyâ€™re not going to dig the skin up.â€ Dr. Friedler says impetigo could end up affecting the face and the eyes, where it can cause swelling. Or it could spread from the outermost layers of the skin to deeper layers. (4)
If impetigo continues to spread and worsen, other bacterial infections can result. Impetigo that progresses without being treated can turn into abscesses (or boils) on the skin, Shubin says. â€œThen itâ€™s no longer impetigo,â€ he says. The recommended treatment changes radically with the development of abscesses. â€œAbscesses donâ€™t really respond to antibiotics; they respond to drainage,â€ Shubin says.
Impetigo can also lead to cellulitis, which is an infection that affects the tissue beneath the skin. (1) Cellulitis usually appears as red, swollen skin that feels warm to the touch. (5) In children, it most likely will show up on the face or neck, while adults tend to see it on their lower legs. Cellulitis is pretty common, but it can become serious if it goes untreated and spreads to the lymph nodes and bloodstream. (1) It could be life-threatening if it causes permanent damage to the lymph vessels, which play a role in the way the immune system functions. (5)
Rarely, Rheumatic Fever
Though itâ€™s not common, itâ€™s possible for impetigo to lead to rheumatic fever. (6) This anti-inflammatory disease is caused by Group A streptococcus infections, and, like impetigo, it affects children (though usually a bit older â€” those ages 5 to 15). In most cases, rheumatic fever starts as strep throat rather than a skin infection like impetigo. Itâ€™s very rare in the United States, but something to be aware of because it can cause serious damage to the heart. Be on the lookout for signs of rheumatic fever, which include fever, joint pain, fatigue, and chest pain. (7)
Also Rarely, Poststreptococcal Glomerulonephritis
Leaving impetigo untreated means the bacteria could eventually hit the bloodstream. Once that happens, the potential complications become quite serious. The most serious potential complication is poststreptococcal glomerulonephritis. (996' target='_blank' rel='noopener noreferrer' >8) This is a kidney disorder that starts somewhere else on the body, such as on the skin, and eventually moves into the kidneys. (9)
Streptococcus bacteria causes inflammation within the blood vessels of the kidneys, which can keep the kidneys from being able to filter urine and could lead to kidney failure. It normally occurs after having a skin infection like impetigo for three or four weeks and leaving it untreated. (9)
How to Spot Signs of an Impetigo Complication
â€œThese [complications] are very rare, but itâ€™s the reason we emphasize why if youâ€™re accurately diagnosed with impetigo you should have treatment,â€ Oza says. In general, impetigo shouldnâ€™t be accompanied by other symptoms, like fever, loss of appetite, vomiting, or unusual drowsiness. If any of those side effects do occur, be sure to visit a health care provider. (10)
How to Help Prevent Impetigo From Recurring
Having impetigo once doesnâ€™t make you immune to the bacteria, so thereâ€™s a chance you or your child will contract it again. (4) The best way to reduce the risk is to maintain healthy skin. For instance, if you or your child has dry, cracked skin, using moisturizer regularly can make a world of difference. â€œSkin is an excellent barrier,â€ Shubin says. â€œOur skin does a wonderful job of protecting us.â€
6 Ways to Spring-Clean Your Skincare Routine
Cuts and bug bites are inevitable, though. Once you see something, cover up the area where the skin has been compromised with Bactroban (mupirocin) and a bandage, Friedler suggests. â€œIf someone has healthy skin, theyâ€™re much less likely to get [impetigo],â€ she says.
And if someone else in your household or your childâ€™s class or day care has impetigo, be diligent about practicing good hygiene. Wash your hands often, avoid sharing towels with anyone whoâ€™s infected, and set the laundry cycle to hot (ideally with a water temperature of at least 140 degrees F) to kill bacteria. (4)
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