Impetigo - a disease of summer heat and close teams

Impetigo is a superficial skin infection caused by staphylococci or streptococci. This is the most common bacterial dermatitis, especially among children, and is highly contagious, and it becomes more active during the summer, as impetigo pathogens are highly transmitted through close direct contact and in a high-temperature environment.

In the summer, dermatologists often notice small epidemics of impetigo, especially in crowded places – such as, for example, camp sites or holiday camps. The following factors contribute to the transmission of infection:

• environment
• high temperature;
• high humidity;
• crowding of people;
• poor hygiene.

Personal features

• poor nutrition;
• compromised immunity;
• the presence of concomitant and debilitating diseases;
• preceding or concurrent systemic therapy with antibiotics, corticosteroids, immunosuppressive or anticancer drugs.

Clinical characteristics and features of the course of impetigo

From the point of view of the clinic, impetigo can be divided into two different forms: impetigo contagious (or vulgar) and impetigo bullous. The first form can be caused by staphylococci or streptococci, or both. The second form is always caused only by staphylococci. Bacteria synthesize exotoxins, which cause true acantholysis of keratinocytes of the upper layer of the epidermis, followed by the development of vesicles and blisters.

Contagious impetigo is initially characterized by the appearance of one or more small, rounded vesicles that contain clear fluid and are surrounded by an erythematous rim. Due to their superficial localization, these vesicles may open, leading to erosions, or they may remain intact. However, their contents become purulent and a pustule develops. Then both erosion and pustules dry out, turning into crusts. The rinds are rather thick, close-fitting and have a characteristic yellowish tint, reminiscent of the color of honey. When the crust is removed, a moist, bright red, erythematous-erosive surface is exposed.

Typical localization of impetigo – exposed surfaces of the body, especially the nose, cheeks, lips and chin. The occluded areas can then be attacked by autoinoculation.

Typical manifestations of impetigo and possible complications

Bullous impetigo presents as isolated vesicles and/or blisters that spread over the trunk and skin folds. These lesions are round, often very large, flaccid, containing a clear fluid that is initially serous and then becomes purulent. The lesions may be accompanied by mild erythema. Both forms of impetigo are characterized by mild itching.

The general condition of the patient with impetigo is quite good, only with diffuse infections fever can sometimes be observed. Both forms of impetigo may resolve spontaneously within a few weeks. With adequate therapy, the duration of the disease is 5-10 days.

The lesions heal without leaving scars. Temporary hyper- or hypopigmentation may persist for several weeks.

Complications (lymphangitis, purulent lymphadenitis, erysipelas, septicemia) are extremely rare. Acute glomerulonephritis, although now less common than in the past, nevertheless remains a severe complication. It usually occurs 3-4 weeks after the onset of lesions on the skin and is initially characterized by proteinuria and microhematuria.

Relapses of impetigo are possible if bacterial foci are not adequately eradicated in the patient and in his immediate environment.

Modern view on the treatment of impetigo

Rapid diagnosis and adequate therapy limit the spread of infection. The patient must be isolated until recovery, ensure that he uses individual personal and bed linen.

In the early stages and in localized impetigo, treatment with a topical antibiotic may be sufficient and should be used for no longer than 14 days to avoid the development of resistant bacteria. Applications with mupirocin, treatment of foci with fusidic acid are effective. With bullous impetigo, gentamicin sulfate in the form of a cream is indicated, but this drug cannot be used systemically at the same time. Benzoyl peroxide can be used successfully as a cleansing agent to prevent relapses (2-3 washes or baths per week).

Thus, the prudent and balanced prescription of antibiotics, as well as the observance of preventive measures for impetigo, contribute to the patient's speedy recovery without the risk of complications.