Impetigo is a highly contagious, superficial bacterial skin infection most commonly affecting children aged 2-5 years. It is the most common bacterial skin infection in children worldwide, caused primarily by Staphylococcus aureus and Streptococcus pyogenes. The infection presents as honey-colored crusted lesions or bullae, typically on the face, arms, and legs. While generally self-limiting, prompt treatment reduces transmission and prevents complications.

Clinical Pearls:

• Most common bacterial skin infection in children
• Peak incidence: 2-5 years, more common in warm, humid climates
• Highly contagious: Spreads through direct contact or fomites
• Two main types: Non-bullous (70%) and bullous (30%)
• Self-limiting but treatment reduces duration and transmission

Red Flags:

• Staphylococcal scalded skin syndrome: Widespread erythema and desquamation
• Cellulitis: Spreading erythema, warmth, systemic symptoms
• Post-streptococcal glomerulonephritis: Hematuria, hypertension, edema
• Systemic symptoms: Fever, lymphadenopathy, malaise
• Ecthyma: Deep ulcerative form with scarring

Non-Modifiable Risk Factors:

• Age: Peak incidence 2-5 years due to immature immune system and close contact
• Genetic factors: Certain HLA types may increase susceptibility
• Atopic dermatitis: 2-3 fold increased risk due to skin barrier dysfunction
• Climate: Warm, humid conditions favor bacterial growth

Modifiable Risk Factors:

• Poor hygiene: Inadequate handwashing and bathing
• Crowded living conditions: Increases person-to-person transmission
• Skin trauma: Cuts, abrasions, insect bites provide entry points
• Nasal carriage: S. aureus nasal colonization increases risk
• Underlying skin conditions: Eczema, scabies, varicella

Environmental Factors:

• Warm, humid climate: Promotes bacterial growth
• Poor sanitation: Contaminated water, inadequate waste disposal
• Shared facilities: Schools, daycares, sports facilities
• Seasonal: Higher incidence in summer months

Protective Factors:

• Good personal hygiene: Regular handwashing, bathing
• Intact skin barrier: Moisturization, avoiding trauma
• Prompt treatment: Early intervention reduces spread
• Isolation: Keeping lesions covered reduces transmission

"What is impetigo?" Impetigo is a common, contagious skin infection that causes sores and blisters, usually on the face, arms, or legs. It's most common in young children and is caused by bacteria. The sores look like honey-colored crusts or blisters that ooze and then form scabs.

"How did my child get it?" Impetigo spreads easily through direct contact with someone who has it, or by touching things they've touched (like towels or toys). It can also start when bacteria get into small breaks in the skin from cuts, scrapes, or insect bites. It's very common in children because they play closely together and may not wash hands as often.

"What symptoms will I see?" You'll notice sores that start as small blisters or red spots, then form honey-colored, golden-yellow crusts. They're usually around the nose, mouth, or on the arms and legs. Sometimes there are larger blisters that look like they're filled with water. The sores may itch a bit but usually don't hurt much.

"How is it treated?" For small areas, your doctor will give you a cream or ointment to put on the sores. You'll apply it 2-3 times a day for about a week. For more widespread infection or if there are blisters, your doctor may prescribe antibiotic pills. It's important to finish all the medicine, even if the sores look better.

"How do I apply the cream?" First, gently wash the sores with soap and water and remove any crusts. Then apply a thin layer of the cream to the sores and a little bit of the skin around them. Wash your hands well after applying. You can cover the sores with a bandage to prevent spreading.

"Is it contagious?" Yes, very contagious! Your child should stay home from school or daycare until the sores are crusted over or they've been on antibiotics for 48 hours. Don't share towels, washcloths, or clothing. Wash bedding and clothes in hot water.

"How long until it's better?" With treatment, the sores usually start looking better in 2-3 days and are mostly healed within a week. Without treatment, it can take 2-3 weeks. Make sure to finish all the medicine your doctor prescribed.

"Can it come back?" It can come back, especially if hygiene isn't good or if your child is around others with impetigo. To prevent it, make sure your child washes hands regularly, keeps nails trimmed, and doesn't share personal items. If someone in the family gets it, everyone should be extra careful about hygiene.

"When should I worry?" Call your doctor if:

• The sores spread or get worse after starting treatment
• Your child develops a fever
• The skin around the sores becomes red, warm, or painful
• Your child seems very sick
• Sores don't start improving after 3-4 days of treatment

"Can I prevent it?" Yes! Teach your child to wash hands regularly, especially after playing. Keep cuts and scrapes clean and covered. Don't share towels, clothing, or personal items. If someone has impetigo, make sure they get treatment right away and keep their sores covered.