Ask the Pharmacist

Q. I was just told my child has impetigo. Can you tell me what that is and what I can do about it?

A. Impetigo is a highly transmissible (contagious) bacterial skin infection that is most common in toddlers but may also present itself in older children or adults. There are two types of impetigo; Bullous and Non-bullous. How do you know which type you have?

Non-bullous is usually caused by the bacteria group A streptococcus and is, by far, more prevalent. It is characterized by clusters of clear, colourless, fluid-filled vesicles with surrounding redness that eventually turn into pustules that break open. As the fluid dries, it forms a thick honey-coloured crust over the lesions. The lesions are often found on the face and extremities with tenderness, itchiness and may be accompanied by swelling of local lymph nodes.

The bullous form of impetigo is usually caused by the bacteria staphylococcus aureus. It has fewer lesions and less redness by comparison and is characterized by large blisters that rupture to form a thin brown crust. These lesions are found mostly on the trunk, extremities and skin folds and often is associated with pain.

Impetigo is often preceded by trauma to the skin resulting in a break to its integrity such as a cut or scrape which then allows bacteria to enter the body. Therefore, it is important to keep the area clean and healthy by washing broken skin immediately and covering with a bandage to prevent infection. Most cases of impetigo resolve on their own in 2 to 4 weeks without any residual scarring however some cases can result in either hyper or hypo pigmentation (lightening or darkening of skin colouring). That being said, if the person develops a fever, extensive fatigue, is immunocompromised or has recurrent episodes then a physician or nurse practitioner should be sought.

Topical (i.e. applied to the skin rather than ingested) antimicrobial therapy may help hasten recovery time by a few days as well as decrease the risk of spread to other body parts or to other people. Though it may seem like a no-brainer to use an antimicrobial in every case, it does increase the risk of resistance (where the antimicrobial may not work for future, perhaps more serious skin infections such as MRSA) and thus a “wait and see” approach is considered prudent. This approach though has to be balanced against “real-life” factors.

Many daycares and schools will not allow affected children back until they have been on antimicrobial therapy for 24 hours. Allowing a child’s immune system a chance to clear the infection on its own is nice in theory, but having that child fall behind in school or forcing a parent to take leave from work in the interim is more than a minor inconvenience and has to be a major consideration in the decision making process.

Whether you choose to treat using a topical antimicrobial or not, some helpful tips you can do at home are:

  • Use warm water or mild soap and water to gently remove crusts. This will not only make the patient more comfortable but also increase absorption of the treatment if using.
  • Saline compresses should be applied for 10 minutes and repeated 3 to 4 times daily to help speed up healing and decrease itchiness
  • Cover the lesions with clean, dry bandages
  • Avoid scratching
  • Keep nails trimmed (for when you cannot resist the itching)
  • Wash hands frequently
  • Avoid sharing towels and wash linens separately to avoid contamination

If you do think that an antimicrobial is warranted, it is important to note that none of the over-the-counter remedies (such as Polysporin) are effective at treating impetigo. Thus, a health care practitioner needs to be consulted to receive a topical antibiotic that is available only by prescription. It is also important to note that topical antimicrobial therapy is just as effective as using an internal antibiotic so there is no need in most cases to take an antibiotic orally and expose the body to other side effects.

In this new age of health care, acquiring an appointment with a physician or other health care provider can be difficult to say the least. In the new year, pharmacists will be able to take some of the load off other health care providers and prescribe for certain minor ailments, non-bullous impetigo being one of them. Pharmacies are currently dealing with a vastly increased workload what with ongoing COVID-19 booster doses, flu shots and managing the ever-expanding shortages of medications (acetaminophen, ibuprofen, cough syrups, amoxicillin etc). As such, it is advised to call ahead and ask if your pharmacy is equipped to prescribe for minor ailments and, for those that are, to make an appointment for a suitable time for a consult. For more information on this or any other heath care related topic, contact your pharmacist.