Impetigo is a common skin disease. It can be described as superficial purulent skin infection. Impetigo can spread very easily in children's collectives and also affects the adults.


The infection is usually caused by bacteria from the group of streptococci or staphylococci. These bacteria invade the surface layers of the skin and cause local inflammation. Staphylococci produce some enzymes, which disrupt the integrity of the skin and allow local bacterial spread. Secondary impetiginization occurs when the bacteria infect an originally non-infectious skin lesion. It is typical for itchy rashes when the skin cover is damaged by scratching allowing the bacteria to penetrate.


There may be various symptoms. Streptococcal lesions usually look like red marks with small blisters filled with pus and they get covered with honey-yellowish crusts. Staphylococcal form looks different due to the action of staphylococcal toxins. There are also red lesions but this time they contain large blisters filled with greenish pus. Blisters are relatively easy to capture and remains at them oozing red bearings. The surface may be covered with crust, but this time they have more brownish coloration. Typical localizations are the cheeks but the inflammation can occur practically anywhere.


Staphylococcal impetigo has a severe form, which is called scalded skin syndrome. It is a situation where the action of staphylococcal toxins is very strong. It occurs more in children. The skin damage is much worse than in “normal” impetigo.  Scalded skin syndrome manifests with development of large reddish skin lesion that resemble the burns and skin layers begin to separate in shreds. It is a life-threatening condition because the damaged skin fails to fulfill its protective function. The victim is at risk of penetration of bacteria into the body, which is quickly followed by sepsis. If the patient survives the acute phase, the skin often heals without leaving any significant scar.


The diagnosis can be confirmed by the naked eye, usually by a dermatologist. If needed, swabs or small samples of tissue from the lesions may be sent for a microbiological examination to confirm the presence of bacteria.


Prevention is important in community of young children, because impetigo tends to spread in children groups. Adequate hygiene with a ban on using the same towels is essential.


The crusts can be removed using local ointments containing salicylic acid or other substances. As the causative factor is bacterial, antibiotic ointments are also effective. In severe forms of the disease and in case of complications (more serious purulent skin infections), antibiotics can be applied orally or intravenously.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources