Impetigo is a bacterial infection that affects the skin. Impetigo in babies may initially appear as harmless blisters but can later spread slowly to the other parts of the body. Further complications may be avoided if this skin condition is diagnosed and treated early. Continue reading this post as we explain what impetigo is, its causes, types, symptoms, treatment, and effective preventive measures in babies.
What Is Impetigo?
Impetigo is a bacterial skin infection caused either by Group A Streptococcus bacteria or Staphylococcus aureus bacteria (1). The bacteria can infect the upper or deeper layers of the skin. There are three types of impetigo (2):
Non-bullous impetigo, also called crusted impetigo, is the most common type that causes smaller sores and blisters. Non-bullous impetigo can be caused either by strep bacteria (Streptococcus) or staph bacteria (Staphylococcus).
Bullous impetigo is a severe form of impetigo that causes large boil-like blisters that could fill with pus and burst. Bullous impetigo takes longer to heal than non-bullous impetigo. Only Staph bacteria cause this infection.
Ecthyma is the most severe variation of impetigo where the bacteria infect the deeper layers of the skin. Ecthyma can be a result of infection by strep, staph, or both. Since ecthyma impacts the deeper layers of the skin, it is also called deep impetigo.
What are the Common Forms Of Impetigo In Babies?
Non-bullous is the most common type of impetigo, constituting about 70% of the total impetigo cases in infants and toddlers (3). However, non-bullous impetigo is very rare among babies aged under two years. While bullous impetigo mostly affects toddlers aged over two years, it can also affect infants and newborns. Ecthyma may often start as bullous or non-bullous impetigo, eventually spreading to the deeper layers of the skin.
How Does A Baby Get Impetigo?
Following are the causes of impetigo in babies:
Contact with an infected person. A baby can catch the infection through physical contact with anyone with impetigo.
Touching objects used by an infected person. Touching toys or other personal items of the infected person can also spread the bacteria.
Infection of an existing rash. Scratching an existing rash, like an insect bite can cause the sore to break. The bacteria that cause impetigo are usually airborne and on the surface of the skin. When the bacteria find an opening in the skin, it colonizes the wound to cause impetigo.
Certain conditions and health background can make some babies more prone to the infection than others.
What Are The Risks Of A Baby Getting Impetigo?
The chances of your baby getting infected by impetigo increase in the following cases: If your baby belongs to the risk group, then keep checking for the symptoms of impetigo.
What Are The Symptoms Of Impetigo In Babies?
The first symptoms of impetigo can emerge anywhere from a day to ten days after contracting the bacteria. They may vary depending on the type of impetigo. Symptoms of non-bullous impetigo
The earliest symptoms of this impetigo are redness around the nostrils and the skin above the upper lip. The fine red rashes turn into large blisters, spreading across the healthier skin on the nose and chin. Rashes soon take the shape of yellowish-red lesions or blisters. The yellow color is due to pus, which are clusters of white blood cells that attack the invading bacteria. The blisters burst and the lesions appear damp due to the fluid. After a few days, the broken blisters turn brownish-red with an outline of red crust around the sore. At this stage, the sore begins to dry and form a flaky crust. The sores are not painful but very itchy, and the baby may attempt to scratch them repeatedly.
Symptoms of bullous impetigo
The first symptom is the development of pink to red-colored lesions on the skin in various parts of the body. Gradually, the blister grows larger and develops a clear fluid within. The fluid gradually turns yellow due to the pus. The lesion itself begins to grow in size while also forming several smaller blisters around it. The blister bursts and the fluid drains away. The upper sheath of the blister dries and forms a white outline around the lesion, which stays red to dark pink for several days. Bullous impetigo blisters mostly appear around skin folds, such as the diaper region and the neck folds.
Symptoms of ecthyma
Large pus-filled sores that mostly appear on the legs (10). Ecthyma sores may also appear on the buttocks. The sores get wider with a perforated circumference. You can tell the sore is quite deep by observing how sunken the center of the lesion appears. The sore can even get wider than an inch. Ecthyma sores can be itchy but are mostly painful. The sore dries, losing the yellow color to turn purple-red.
Sometimes, the baby may also develop a mild fever while the bacteria spread rampantly to the healthy skin. So take your baby to the doctor if you suspect they have impetigo.
How Is Impetigo In Babies Diagnosed?
A doctor can diagnose impetigo by visually assessing the sores. In some cases, the doctor may take a scraping from the sore or a sample of the fluid from the blister and send it for laboratory analysis. The presence of bacteria in the sample will confirm impetigo.
How Is Impetigo In Babies Treated?
The following two measures help treat impetigo in babies (11):
- Topical antibiotics: The compound called mupirocin is the most effective topical antibiotic for impetigo treatment (12). Doctors may prescribe a mupirocin cream or an ointment with mupirocin and other compounds, depending on the extent of infection. Antibiotic creams are applied liberally to the affected parts. The doctor may also suggest using warm water to clean the sores. This helps remove the crusts of the dead skin, thus making the skin permeable to the cream. As they have no side effects, topical antibiotic creams are often the first choice for treating impetigo in babies.
- Oral antibiotics are preferred when impetigo has spread to larger part of the skin. Common oral antibiotics used for impetigo treatment are penicillin and amoxicillin (13). Oral antibiotics have several side effects including severe abdominal discomfort and are avoided by pediatricians unless necessary. The baby will start feeling better within a few days of commencing the treatment. The infection will resolve completely within ten days to two weeks, depending on the extent of the infection. Complete the entire course of medication even if the baby shows improvement within days. Completing the antibiotic course helps minimize recurrence and also prevents the bacteria from becoming antibiotic-resistant. Non-bullous and bullous impetigo does not leave scars, but ecthyma blisters leave scars. While treatment with medicines is vital, appropriate home management is also essential.
How Can Parents Manage Impetigo In Infants?
Here are a few tips to help the baby recover faster and prevent the chances of spreading the infection (14) (15):
Keep the sores covered. Dead skin from the sores and fluid from the blisters can spread the disease to the rest of the body, and to other people coming in contact with the baby. Therefore, it is important to keep the sores covered. Dress the baby in loose clothing that covers the scars but also allows ventilation. You can also cover the sores with loose gauze bandages.
Trim the baby’s nails. Impetigo often spreads from the infected to the healthy skin through the fingernails. Trim the baby’s nails to ensure that the bacteria do not accumulate under the nails. Clipping the nails also minimizes the chances of scratching and bursting the blisters.
Give diaper breaks. Bullous impetigo can cause sores around the diaper area. Let the baby stay without a diaper for a few minutes every day to air-dry the affected part. Air circulation allows the sores to dry quicker, which can accelerate the healing process.
Wash the baby’s hands periodically. Your baby may accidentally touch a sore and place the hand on other parts of the body or a caretaker’s skin. Wash the baby’s hands with a safe disinfectant soap once in every six hours to prevent the accumulation of the strep and staph bacteria on the palms.
Clean sores once a day with warm water. Besides a warm water bath every day, clean the sores once every eight to 12 hours with warm water. Your baby’s pediatrician can prescribe a water-soluble anti-bacterial liquid to add to the water.
Wash the baby’s laundry separately. Use warm water to wash the baby’s clothes separately. Use a disinfectant detergent to do the washing. Also, wipe clean the baby’s toys, and other personal items with a towel dipped in the disinfectant liquid.
Stay indoors. Avoid going to the park or sending your baby to daycare. An infant with impetigo can quickly spread the disease to other healthy infants around them.
Family members must observe precautions. Primary caretakers must wash hands every time they clean the baby’s sores. It is best to wash hands after you hold the baby or their items of use. Ask other members of the family to keep a distance from the infant and do not touch the baby’s items.
Impetigo stops being contagious 48 hours after the treatment begins (16). Nevertheless, it is best to observe precautions until the sores dry entirely.
Can Impetigo In Babies Go Away Without Treatment?
Yes. Impetigo can resolve in 10-12 days without treatment. However, the American Academy of Dermatology states that skipping impetigo treatment can cause the bacteria to infect the deeper layers of the skin, leading to complications (17), which can be fatal for an infant. Hence, do not leave your baby’s impetigo untreated.
What Are The Complications Of Untreated Impetigo?
Untreated impetigo can cause the following complications in babies: Treatment helps your baby avoid complications. But prevention is always better than cure.
How To Prevent Impetigo In Babies?
Preventing impetigo in infants is easy with the following steps:
