Treatment of impetigo is swift if a parent notices signs of the infection — such as red sores on the child’s nose, mouth, hands, or feet — and seeks help from a healthcare provider. “Usually impetigo will appear with honey-colored substances on the skin,” says Vikash S. Oza, MD, a pediatric dermatologist at NYU Langone Health in New York City. “They’ll start as very tiny superficial sores or tiny bumps that form a particular crust right on top of it.” The honey-colored crusts take the place of the sores once they burst. (1) Doctors say impetigo is extremely common among children, especially in warmer months when kids are outside doing things they wouldn’t do indoors. They also may be getting more bug bites or scrapes in the summer, which can increase the risk of developing impetigo. “There are things that mimic it, and that’s why you may want to see a provider for a diagnosis,” Dr. Oza says. Impetigo is sometimes mistaken for: Herpes In many cases, cold sores look like they could be impetigo, including when they burst and crust over. Crusting is a very common presentation of impetigo. Shingles Shingles occurs more often in adults than children, and it’s accompanied by something impetigo normally is not: pain. Shingles can be very painful because it’s in the nerve. Impetigo, on the other hand, is much more superficial, and while it can sometimes be itchy, it’s not usually painful. (2) Hand, Foot, and Mouth Disease Normally, the dead giveaway that it’s hand, foot, and mouth disease and not impetigo is the appearance of sores inside the mouth. Impetigo is a skin infection — and there is no skin in the mouth. That sounds simple enough, but it’s complicated by the fact that a recent strain of hand, foot, and mouth disease in the United States has resulted 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, “you should get a widespread rash where you have red spots on the palms and soles and occasionally elsewhere on the arms and legs,” Oza says. It’s also usually accompanied by other symptoms, including fever, sore throat, and loss of appetite. (3) Doctors often prescribe cephalexin (Keflex) for impetigo to treat both strains of bacteria simultaneously. (8) Once treatment begins, the infection will likely go away within a few days, though it’s important to completely finish the antibiotics prescribed by the doctor to keep the infection from appearing again.
Spreading the Infection to Others
This is the biggest thing to worry about when it comes to impetigo. “The most obvious complication is it will continue to spread to other areas, and you’ll see crusting and sores on the skin,” Oza says. To minimize the chances of spreading to other parts of the body, parents should take measures to keep kids from getting bacteria under their fingernails. Impetigo doesn’t usually itch too much, but it can be uncomfortable and kids may pick at the infected sores. (1) So trim their nails to keep them short, and if they’re still scratching, consider putting socks on their hands to prevent digging into the skin. 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.
Bacterial Infections
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. The recommended treatment changes radically with the development of abscesses, which don’t respond well to antibiotics and require drainage.
Cellulitis
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 it’s not common, it’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 — those ages 5 to 15). In most cases, rheumatic fever starts as strep throat rather than a skin infection like impetigo. It’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. 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) Cuts and bug bites are inevitable, though. Once you see something, cover up the area where the skin has been compromised with mupirocin (Bactroban) and a bandage, Friedler suggests. “If someone has healthy skin, they’re much less likely to get [impetigo],” she says. And if someone else in your household or your child’s class or day care has impetigo, be diligent about practicing good hygiene. Some tips from TeensHealth: Wash your hands often, avoid sharing towels with anyone who’s infected, and set the laundry cycle to hot (ideally with a water temperature of at least 140 degrees F) to kill bacteria.
