Impetigo is a common condition. It most often affects children although it can occur at any age. Annual incidence in the UK is estimated to be 2.8% of children under the age of 4 years and 1.6% of children aged 5-15 years 1. Global estimates suggest around 162 million children have impetigo at any one time, prevalence being highest in tropical areas and underprivileged communities. The streptococcal form is more common in warmer and more humid climates. There is some evidence for seasonal variation, with staphylococcal infections being more common in warmer months
Management
General advice
Advise good hygiene measures:
• Keep the affected area(s) clean.
• Wash hands after touching affected area(s).
• Avoid sharing of towels and bathwater.
• Avoid scratching the affected area. Keep fingernails short and clean.
Public Health England (PHE) advises that children should stay off school (or adults should stay off work) until lesions are all dry and scabbed over, or the affected person has been on antibiotics for 48 hours.
Topical antibiotics
A Cochrane review found good evidence for efficacy of topical mupirocin and fusidic acid, and that they were as effective as oral antibiotic treatment. There was no evidence for topical disinfectants being effective therapy. Opinion varies as to whether crusts should be soaked off prior to applying topical treatment. The National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary on impetigo advises that fusidic acid be used first-line in localized infections, three times a day for seven days. Mupirocin should be reserved for cases where MRSA is the causative organism, to avoid resistance.