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28 Vo Truong Toan Street, An Phu Ward, District 2, Ho Chi Minh City, Vietnam Tel: (84-8) 3898 9100 - Fax: (84-8) 3898 9382 Email: [email protected] www.ishcmc.com IMPETIGO Impetigo is seldom serious, but it is a highly contagious skin infection that mainly affects infants and children. Impetigo usually appears as red sores on the face, especially around a child's nose and mouth. Although it commonly occurs when bacteria enter the skin through cuts or insect bites, it can also develop in skin that's perfectly healthy. Impetigo is seldom serious, and usually clears on its own in two to three weeks. But because impetigo can sometimes lead to complications, your child's doctor may choose to treat impetigo with an antibiotic ointment or oral antibiotics. Our school policy is that a child with Impetigo can return to school as soon as he or she has started antibiotic treatment and as long as the sores are covered. Symptoms The following are signs and symptoms of impetigo: � � � � Red sores that quickly rupture, ooze for a few days and then form a yellowish brown crust Itching Painless, fluid-filled blisters In the more serious form, painful fluid - or pus-filled sores that turn into deep ulcers Types of impetigo � � � Impetigo contagiosa. The most common form of impetigo is impetigo contagiosa, which usually starts as a red sore on your child's face, most often around the nose and mouth. The sore ruptures quickly, oozing either fluid or pus that forms a honey-colored crust. Eventually the crust disappears, leaving a red mark that heals without scarring. The sores may be itchy, but they aren't painful. Your child isn't likely to have a fever with this type of impetigo but may have swollen lymph nodes in the affected area. And because it's highly contagious, just touching or scratching the sores can spread the infection to other parts of the body. Bullous impetigo. This type primarily affects infants and children younger than 2 years. It causes painless, fluid-filled blisters — usually on the trunk, arms and legs. The skin around the blister is usually red and itchy but not sore. The blisters, which break and scab over with a yellow -colored crust, may be large or small, and may last longer th an sores from other types of impetigo. Ecthyma. This more serious form of impetigo penetrates deeper into the skin's second layer (dermis). Signs and symptoms include painful fluid - or pus-filled sores that turn into deep ulcers, usually on the legs and f eet. The sores break open and scab over with a hard, thick, gray -yellow crust. Scars can remain after the sores heal. Ecthyma can also cause swollen lymph glands in the affected area. Fostering Individual Ability 28 Vo Truong Toan Street, An Phu Ward, District 2, Ho Chi Minh City, Vietnam Tel: (84-8) 3898 9100 - Fax: (84-8) 3898 9382 Email: [email protected] www.ishcmc.com Impetigo contagiosa starts as a red sore that ruptures, oozes for a few days and then forms a honey-colored crust. Sores mainly occur around the nose and mouth in infants and children. Bullous impetigo causes fluid-filled blisters — often on the trunk, arms and legs of infants and children younger than 2 years. The skin around the blister is usually red and itchy but not sore. Ecthyma is characterized by painful fluid - or pus-filled sores that turn into deep ulcers, usually on the legs and feet. Scars usually remain after the sores heal. When to see a doctor If you suspect that your child has impetigo, please bring them into the school clinic for an assessment or consult your family doctor, your child's pediatrician or a Fostering Individual Ability 28 Vo Truong Toan Street, An Phu Ward, District 2, Ho Chi Minh City, Vietnam Tel: (84-8) 3898 9100 - Fax: (84-8) 3898 9382 Email: [email protected] www.ishcmc.com dermatologist. Your doctor can recommend a treatment plan based on the type of impetigo and severity of the infection. Causes Two types of bacteria cause impetigo — Staphylococcus aureus (staph), which is most common, and Streptococcus pyogenes (strep). Both types of bacteria can live harmlessly on your skin until they enter through a cut or oth er wound and cause an infection. In adults, impetigo is usually the result of injury to the skin — often by another dermatological condition such as dermatitis. Children are commonly infected through a cut, scrape or insect bite, but they can also develop impetigo without having any notable damage to the skin. You're exposed to the bacteria that cause impetigo when you come into contact with the sores of someone who's infected or with items they've touched, such as clothing, bed linen, towels and even toys. Once you're infected, you can easily spread the infection to others. Staph bacteria produce a toxin that causes impetigo to spread to nearby skin. The toxin attacks a protein that helps bind skin cells together. Once this protein is damaged, bacteria can spread quickly. Risk factors Although anyone can develop impetigo, children ages 2 to 6 years and infants are most often infected. Children are especially susceptible to infections because their immune systems are still developing. And because staph and st rep bacteria flourish wherever groups of people are in close contact, impetigo spreads easily in schools and child care settings. Other factors that increase the risk of impetigo include: � � � Direct contact with an adult or child who has impetigo or with conta minated towels, bedding or clothing Crowded conditions Warm, humid weather –Vietnam! Older adults and people with diabetes or a compromised immune system are especially likely to develop ecthyma, the most serious form of impetigo. Complications Impetigo typically isn't dangerous, but sometimes it may lead to rare but serious complications, including: Fostering Individual Ability 28 Vo Truong Toan Street, An Phu Ward, District 2, Ho Chi Minh City, Vietnam Tel: (84-8) 3898 9100 - Fax: (84-8) 3898 9382 Email: [email protected] www.ishcmc.com � � � Poststreptococcal glomerulonephritis (PSGN). This kidney inflammation may develop after a streptococcal infection such as strep throat or impetigo. It occurs when antibodies formed as a result of the infection damage the small structures (glomeruli) that filter waste in your kidneys. Although most people recover without any lasting damage, PSGN may lead to chronic kidney failure. Signs and symptoms of PSGN com monly appear about two weeks after an infection. They include facial swelling — especially around the eyes — decreased urination, blood in the urine, high blood pressure, and stiff or painful joints. Most often, PSGN affects children between the ages of 6 and 10 years. Adults who develop PSGN tend to have more serious symptoms than children do and are less likely to make a full recovery. Although antibiotics can cure strep infections, they don't prevent PSGN. Cellulitis. This potentially serious infection affects the tissues underlying your skin and eventually may spread to your lymph nodes and into the bloodstream. Left untreated, cellulitis can quickly become life -threatening. Methicillin-resistant Staphylococcus aureus (MRSA) infection. MRSA is a strain of staph bacteria that resists most antibiotics. It can cause serious skin infections that are extremely difficult to treat. The skin infection may start as a red, swollen pimple or boil that drains pus. MRSA may also cause pneumonia and blood infections. Other complications include: � � Scarring Lightening (hypopigmentation) or darkening (hyperpigmentation) of the skin Tests and diagnosis Doctors usually diagnose impetigo by considering signs and symptoms and medical history and looking at the distinctive so res. Your doctor will likely ask about any recent cuts, scrapes or insect bites to the affected area. A culture may be necessary to confirm the diagnosis or to rule out another cause. During this test, your doctor uses a sterile swab to gently remove a sma ll bit of pus or drainage from one of the sores. The sample is then cultured in a laboratory for the presence of bacteria. Treatments and drugs Impetigo treatment can speed the healing of the sores, improve the skin's appearance and limit the spread of the infection. How impetigo is treated depends on several factors, including the type of impetigo and the severity of the infection. Treatments include: Fostering Individual Ability 28 Vo Truong Toan Street, An Phu Ward, District 2, Ho Chi Minh City, Vietnam Tel: (84-8) 3898 9100 - Fax: (84-8) 3898 9382 Email: [email protected] www.ishcmc.com Hygienic measures. Sometimes your doctor may choose to treat minor cases of impetigo with only hygienic me asures. Keeping the skin clean can help mild infections heal on their own. � Topical antibiotics. Your doctor may prescribe a prescription antibiotic that you apply to the affected areas (topical antibiotic), such as Bactroban or Fucidin. Before applying the antibiotic, you need to gently remove any scabs so that the antibiotic can penetrate the sore. � Oral antibiotics. Antibiotics you take by mouth (oral antibiotics) may be prescribed for widespread impetigo, ecthyma and severe cases of impetigo contagiosa. The specific antibiotic depends on the severity of the infection and any known allergies or medical conditions. Be sure to finish the entire course of medication even if the sores are healed. This helps prevent the infection from recurring and makes antib iotic resistance less likely. � Prevention Keeping the skin clean is the best way to keep it healthy. Treat cuts, scrapes, insect bites and other wounds right away by washing the affected areas and applying antibiotic ointment to prevent infection. If someone in your family already has impetigo, follow these measures to help keep the infection from spreading to others: � � � � � Gently wash the affected areas with mild soap and running water and then cover lightly with gauze. Wash an infected person's clothes, linens and towels every day and don't share them with anyone else in your family. Wear gloves when applying any antibiotic ointment and wash your hands thoroughly afterward. Cut an infected child's nails short to prevent damage from scratching. Wash hands frequently. If you have any questions, please contact the school clinic at 3898 -9100 ext 105. Fostering Individual Ability