Impetigo in children: a clinical guide and treatment options

Impetigo is a contagious, superficial bacterial infection of the skin, most frequently encountered in children. Causative organisms are almost always Staphylococcus aureus or streptococci, or a combination of the two. Predisposing factors are nasal and perineal colonisation, overcrowding, poor personal hygiene, minor skin trauma and pre-existing skin diseases with disrupted skin barrier function, like eczema. Infection is mainly acquired through contact with sufferers or nasal carriers. Treatment should be given to avoid spread of the disease, and to minimise the risk of infecting others. Although the majority of cases of impetigo are self-limiting, under certain circumstances complications like toxic shock syndrome, staphylococcal osteomyelitis, septic arthritis and pneumonia can occur. Furthermore, certain strains of group A beta-haemolytic streptococci causing impetigo may result in poststreptococcal glomerulonephritis, just like streptococcal throat infections can result in rheumatic fever in children, but the pathogenesis remains poorly understood. It appears to be due to abnormal immune response or hypersensitivity to streptococcal antigens.