Impetigo Contagiosa: Causes, Symptoms & Treatment

Impetigo contagiosa is a highly contagious bacterial infectious disease that occurs primarily in neonates and children. However, the infection can occur in principle at any age. Synonyms are pustule, grind lichen, bark lichen or drag. The face and extremities are usually affected.

What is impetigo contagiosa?

Impetigo contagiosa is one of the bacterial infections of the skin. It occurs frequently and is highly contagious. Although the infection can affect any age, children and newborns are most commonly affected. There are two forms of impetigo contagiosa that have different bacteria as their cause. The small vesicular form is caused by group A beta-hemolytic streptococci. The causative agent of the large blistered form is Staphylococcus aureus. The incubation period is two to ten days. There is a risk of infection as long as open, purulent skin areas have not yet healed. During this time, the vesicles or their contents are highly contagious.

Causes

Impetigo contagiosa is transmitted by smear infection with the above bacteria. The bacteria are also found in the nasopharynx in many healthy people. The disease occurs when the pathogen can enter the bloodstream through scratched or injured skin and destroy tissue there. For this reason, children with neurodermatitis, chicken pox or scabies, for example, are particularly susceptible to impetigo contagiosa. The bacteria are transmitted through direct contact or contaminated hands (smear infection). They also survive for a long time on glasses or other objects. Thus, indirect transmission is also possible when a contaminated object is used by several people. Infection spreads particularly easily, of course, in community settings such as schools or kindergartens.

Symptoms, complaints, and signs

The three forms of impetigo contagiosis are manifested by predominantly uniform symptoms. Typical are the small, white to reddish blisters on the skin. These skin lesions, which are very small in the nonbullous form and therefore hardly visible, burst open after some time, and yellowish crusts form. Then itching often sets in as well. The blisters can occur selectively or over a large area. In severe cases, a large part of the skin is affected. In small vesicular impetigo contagiosa, the vesicles are small and filled with pus, and burst open after a few days due to their thin skin. Large blistered impetigo contagiosa is manifested by larger skin lesions with thicker skin. They are clear at the beginning and slowly become cloudy. The vesicles burst after one to two weeks, leaving behind the characteristic crusting. Non-bullous impetigo contagiosa produces few or no vesicles, although yellowish crusts still appear. In rare cases, the changes in the skin are accompanied by a fever. The elevated body temperature is accompanied by typical signs of illness, such as chills and malaise, and subsides after a few days.

Diagnosis and course

The physician can make a diagnosis of impetigo contagiosa on the basis of a visual diagnosis, since the rash is typical of the disease. For this purpose, a skin swab (also swab of the nasal and pharyngeal cavities) is also possible to detect the pathogen in case of doubt. Differentially, the physician excludes a herpes simplex infection. The rash in impetigo contagiosa is typical. The patient presents with golden-yellow, red-rimmed crusts that appear primarily around the mouth and nose and on the hands. Initially, the skin is slightly reddened and vesicles form that are filled with fluid or pus. In the small blister form, the wall of the blisters is very thin and bursts quickly. This results in the formation of the honey-yellow scab typical of the disease. In large-blistered impetigo contagiosa, the patient may also develop a fever and show swelling of the lymph nodes. The fluid of the vesicles is highly contagious. Crusting is more severe in the small-blistered form than in large-blistered impetigo contagiosa. Eventually, the skin scales fall off on their own or can be removed by hand. With consistent therapy and adherence to hygienic regulations, the infection usually heals without consequences. However, complications may occur during the course of the disease. Thus, the patient may develop postinfectious glumeronephritis, lymphadenitis, or regional lymphangitis.

Complications

Impetigo contagiosa causes discomfort mainly on the patient’s extremities and face. In most cases, blisters form on the skin and the affected person suffers from a severe rash. This rash may be itchy and blisters may also form that are filled with pus. The patient’s quality of life is significantly reduced by impetigo contagiosa and there is often a lowered self-esteem due to the aesthetic limitations. It is not uncommon for those affected to also suffer from inferiority complexes and depression. They withdraw from social life and also suffer from severe fatigue. Furthermore, swelling of the lymph nodes and the development of fever may also occur. The affected person also suffers from reduced resilience. The treatment of impetigo contagiosa does not lead to any further restrictions or complications. This usually takes place with the help of antibiotics and also leads relatively quickly to a positive course of the disease. The life expectancy of the patient is not limited by the disease. However, scars may form in severe cases.

When should one go to the doctor?

If the child shows symptoms of skin disease, he should be taken to the pediatrician the same day. External signs such as pus blisters, yellowish crusts or redness indicate that it is impetigo contagiosa – a disease that must be treated by a doctor in any case. Parents who notice such symptoms in their child are best to consult the dermatologist immediately. This is especially true if the child complains of increasing pain and itching. At the latest, if the blisters open or even become inflamed, the child must receive medical attention. Children who have recently had chickenpox or scabies or suffer from neurodermatitis are particularly susceptible to impetigo contagiosa. Parents should seek medical attention if the above symptoms are noticed in association with any of these conditions. If the symptoms are severe, the child should be taken to a hospital. Further treatment is provided by the dermatologist or an internist.

Treatment and therapy

Because of possible secondary diseases, the physician treats impetigo contagiosa systemically with antibiotics (amoxicillin or flucoxacillin) in more severe cases. For the affected skin areas themselves, the doctor also prescribes ointments containing antibiotics, such as fusidic acid, mupirocin or retapamulin. Baths and compresses with disinfecting solutions are also helpful.

Outlook and prognosis

With expert treatment, the prospects for curing impetigo contagiosa are very good. The borky lichen often heals spontaneously. Nevertheless, those with impetigo contagiosa should not wait to see if this happens. It is safer to start treatment for the infection and avoid spreading impetigo to other areas of the skin. Even with medical treatment, it may take weeks for all signs of the lichen to disappear. Affected areas of the skin later show pus-filled pustules that open quickly and leave yellow crusts. This is not only unsightly, but also contagious. Therefore, the infection will spread if the affected person does not take it seriously enough and carries germs by misbehaving. The spread of impetigo contagiosa to other areas of the skin may well lead to secondary diseases. In the case of purulent conjunctivitis, the eyes are affected, and in the case of otitis media, the ears are affected. In addition, prolonged courses can lead to glomerulonephritis. This worsens the prognosis. Depending on whether staphylococci or streptococci triggered the impetigo contagiosa, further consequences may occur if the infection is left untreated. For example, staphylococci may cause sepsis or inflammation of the lymphatics. Kidney damage such as postinfectious glomerulonephritis can occur from untreated streptococcal infections.

Prevention

Spread can only be prevented by consistent adherence to all hygienic measures. Under no circumstances should the patient himself scratch the highly infectious vesicles. In the case of children, parents can therefore also cut the fingernails as short as possible. Regular hand washing of the patient and, of course, of all contact persons is essential.All clothing worn by the patient and all used towels and also bed linen must be boiled at 60°C. This can contain the infection and prevent it from spreading. To avoid infecting other people, the patient must not visit community facilities such as schools or kindergartens again until the infected skin areas have healed completely. This is the case when the crusts have completely fallen off.

Aftercare

In most cases of impetigo contagiosa, there are no special aftercare options available to the affected person. Therefore, the earlier the disease is detected, the better is usually the further course, so that the affected person should ideally see a doctor already at the first complaints and symptoms. Impetigo contagiosa cannot heal itself. In most cases, the disease is treated by taking various medications. If antibiotics are administered, the affected person should not take them together with alcohol, as their effect will otherwise be significantly alleviated. Likewise, care should be taken to ensure that they are taken regularly and also in the correct dosage. A doctor should always be consulted first if there is any uncertainty or if there are any questions. Furthermore, special measures are usually no longer necessary. Impetigo contagiosa does not reduce the life expectancy of the affected person. However, the patient should take it easy and rest. From efforts or from stressful activities is to be refrained in any case, in order not to load the body unnecessarily.

What you can do yourself

In case of impegno contagiosis, medical treatment is required in any case. Medical therapy can be supported by some self-help measures and various household and natural remedies. The most important measure is to remove the crusts twice a day. For this, an antiseptic solution is needed, which softens the crusts and thus prevents injury to the skin. Afterwards, the wound can be treated with an antiseptic ointment or a local antibiotic and closed with a fresh bandage. When removing the crusts, care must be taken to ensure thorough hygiene, otherwise inflammation may occur. If larger areas of skin are affected, disinfecting baths with quinolinol or potassium permanganate are recommended. In the case of a chronic course, treatment with antibiotics is necessary. Medicinal preparations as well as strict hygiene measures help against itching. Affected persons should wash their hands frequently and thoroughly and not bathe with other family members or their partner. In addition, fingernails should be cut regularly and towels should be washed hot after use. Affected individuals should take a sick leave for at least one to two weeks. Only when the doctor gives the all-clear may direct physical contact with other people be resumed.