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Impetigo vs hand foot and mouth: 10 Common Questions About Impetigo

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10 Common Questions About Impetigo

Impetigo is a contagious bacterial skin infection that mainly affects young children. (1) “Children get impetigo when they come into contact with someone who is infected or if they’ve shared some of the same clothes, bedding, towels, or other intimate articles of an infected person,” says Lisa Denike, MD, a pediatrician with Kaiser Permanente based in Vancouver, Washington.

It’s extremely common — there are more than three million cases in the United States each year. (2) In Europe, 2 out of every 100 children contract impetigo annually, making it the most common skin infection among kids. (3)

Here, we answer 10 frequently asked questions associated with impetigo and its diagnosis, symptoms, and treatments.

1. Is Hand, Foot, and Mouth Disease the Same Thing as Impetigo?

No. Though hand, foot, and mouth disease is also found in young children and is also contagious, it’s a virus, whereas impetigo is a bacterial infection. (4)

Normally, the easiest way to tell the difference between impetigo and hand, foot, and mouth disease is to note where the rash and sores appear. Hand, foot, and mouth disease, by definition, appears frequently on the palm, soles, and inside the mouth, while impetigo does not show up in the mouth. Sounds straightforward, but Vikash S. Oza, MD, a pediatric dermatologist at NYU Langone Health in New York City, says that recent strains of hand, foot, and mouth disease appear outside of the mouth instead of inside, making it appear more like impetigo.

Be on the lookout for other symptoms: Hand, foot, and mouth disease is often accompanied by fever, loss of appetite, irritability, and sore throat, while impetigo in the early stages is strictly a skin condition. (4)

2. Typically, How Is Impetigo Diagnosed?

Often, your healthcare provider will identify impetigo simply by looking at the skin. (5)

Normally, if the provider feels confident the person is displaying signs of impetigo, a lab test won’t be needed. But Dr. Denike says a doctor may take a sample from the skin to do a bacterial culture if the infection doesn’t go away after treatment. They will test the sample in the lab to determine the type of bacteria causing the issue. (5)

It usually takes about 48 hours to get results, Dr. Oza says.

More on Impetigo Symptoms

How to Spot the Signs of Impetigo and When to Seek a Diagnosis

3. Impetigo Is Common in Kids — but Can Adults Get the Condition, Too?

Impetigo is most common among children or teenagers who engage in high-contact sports like wrestling, says Suzanne Friedler, MD, a board-certified fellow of the American Academy of Dermatology and a clinical instructor at Mount Sinai Medical Center in New York City. But adults can get impetigo as well.

Because adults don’t engage in as much skin-to-skin contact as children do, oftentimes a child will pass impetigo to a parent. “It is contagious, typically through contact, so sometimes in more extensive cases of impetigo we’ll start to see other family members who are affected,” Oza says.

4. Based on What We Know, What Is the Main Cause of Impetigo?

Impetigo is caused by bacteria, either streptococcus (the cause of strep throat) or staphylococcus (which causes staph infections). (3) These bacteria are all around us every day but can become an issue if the bacteria enter the skin, which they do can if there’s a cut, scrape, bug bite, rash, or a skin condition like eczema.

Impetigo is more common in the summer and in warm, humid climates, but it can occur anywhere, according to the Centers for Disease Control and Prevention (CDC).

5. Do You Need Antibiotics to Heal Impetigo?

Treating impetigo with antibiotics speeds up the healing process, with improvement often in just a few days, and it keeps the infection from spreading. Impetigo may go away on its own within two to four weeks, but not treating it means it’s likely to spread to other people or other parts of the body. (2,6)

Unfortunately, there isn’t an over-the-counter treatment option available, so antibiotics are needed to zap the bacteria. For a mild case, doctors will likely prescribe a topical antibiotic that is applied directly to the skin. For more widespread cases, oral antibiotics may be necessary. (2)

6. What Are the Signs and Symptoms of Impetigo?

“Within three days of infection, a person will develop small red spots,” Denike says of nonbullous impetigo. These usually occur around a child’s nose, mouth, or limbs. (6) The spots can turn into blisters, and when they burst, honey-colored crust takes their place. (3)

Bullous impetigo, the less common type, is marked by fluid-filled blisters on the arms, legs, or area between the neck and the waist. (6) When these burst, yellow crust appears.

Nonbullous impetigo sores are not painful, but bullous blisters can be. (6)

7. Generally, How Long Will It Take for Impetigo to Go Away?

A doctor might prescribe an antibiotic for 7 to 10 days, though you will likely see a response within 72 hours, Oza says.  Impetigo may go away within a few weeks on its own. (6)

8. Is Impetigo Contagious, and if So, How?

Yes, impetigo is contagious. (2) “If the child or infected person scratches or touches the sore and then touches a surface or a toy, other children can get it if they touch that same surface or toy,” Denike says. “For this reason, it spreads easily in day care and schools.”

An abrasion in the skin — such as a scrape or a bug bite — gives the bacteria an entry point, which can lead to infection. (2) The infection is no longer contagious 24 hours after starting an antibiotic treatment. If left untreated, however, it will remain contagious for several weeks. (3)

More on Skin Conditions and Contagion

How Ringworm Spreads, and How to Deal With It

9. If You Suspect It’s Impetigo, at What Point Should You Call a Doctor?

Although impetigo can be confused with other skin conditions, going to see a doctor if you show symptoms can help ensure you get the right diagnosis. “It’s important to contact the doctor right away, because an infected child typically needs treatment, and it’s contagious,” Denike says. You should visit a doctor if you see classic signs of impetigo.

10. How Can You Help Keep Impetigo From Spreading to Others?

Existing infections that are localized should be treated with topical antibiotics and covered with a bandage, the CDC says.

Parents should also keep the child’s fingernails trimmed. This will keep bacteria from getting under the nail and spreading when the child scratches other parts of the body. Other people in the household should also avoid sharing towels and sheets if one child has impetigo, and dirty laundry should be washed at a temperature of at least 140 degrees F. (3)

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by Marie

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Does your child have sores on or in his mouth. This post will focus on Impetigo vs Hand Foot and Mouth Disease to help you decipher exactly what your child has.

So the other day, my one-year-old came down with a fever. At first I thought he was teething or had a cold. However, right after his fever broke, tiny little sores started to appear around his mouth and on his hands and feet. Earlier that week he had been playing with his cousin who came down with Impetigo (a contagious infection of the skin). So, I figured that he had caught it from him.

Well, I was wrong. After talking to the nurse at his pediatrician’s office, it turns out he had Hand, foot and mouth disease (HFMD)! Both illness have some similarities and some differences. And both are fairly common among toddlers and babies. Listed below are some ways to recognize illnesses and how to treat them.

My little squirt who got HFMD. The separate photo shows where the sores developed near his mouth.

Recognize the symptoms

Hand, foot and mouth disease: It usually starts with a fever, reduced appetite, sore throat, and a feeling of being unwell. One or two days after the fever starts, painful sores can develop in the mouth. The mouth sores begin, often in the back of the mouth, as small red spots that blister and can become ulcers. A skin rash with red spots, and sometimes with blisters, may also develop over one or two days on the palms of the hands and soles of the feet; it may also appear on the knees, elbows, buttocks or genital area, according to the Centers for Disease Control.

Impetigo:  It is a common and 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, and on hands and feet. The sores burst and develop honey-colored crusts, according to the Mayo Clinic.

Comparing both illnesses: After simply talking to the nurse over the phone, she knew my son had HFMD because he had sore INSIDE his mouth. Impetigo only produces sores on the skin itself.  Also, since my son had a fever, that was also a big indication that it was NOT IMPETIGO. Also, since the sores were concentrated on the feet, hand, and mouth, that was a big indication of HFMD and not Impetigo.

Sores on my son’s toes from HFMD (left). A large sore from Impetigo behind the knee of my nephew (right).

Hand, foot and mouth disease: Unfortunately, there is no specific treatment for this disease. You’ll just have to let it ride its course. However, you can give your child some over-the-counter pain reliever and sprays for the mouth to numb the pain according to the CDC.  The nurse from my pediatrician’s office recommended Mylanta to soothe the pain as well. My sister is big on essential oils and she recommended some Melaleuca oil for his mouth. I didn’t try that but might be a good option.

Impetigo: The good news is Impetigo typically is treated with an antibiotic ointment or cream that you apply directly to the sores. You may need to first soak the affected area in warm water or use wet compresses to help remove the scabs so the antibiotic can penetrate the skin according to the Mayo Clinic.

If you have more than just a few impetigo sores, your doctor might recommend antibiotic drugs that can be taken by mouth. Be sure to finish the entire course of medication even if the sores are healed. This helps prevent the infection from recurring and makes antibiotic resistance less likely.

I hope the above information was helpful. Since I am not a medical professional I recommend consulting a medical professional before diagnosing or treating any illness. The websites below provide additional information about these two specific illnesses.

  • Impetigo overview including treatment, prevention and symptoms and causes.
  • Hand, foot and mouth disease overview including treatment, prevention and symptoms and causes.

You can also print this FREE HANDOUT – Impetigo vs. Hand foot and mouth disease.

Have you had any experiences with these illnesses? Leave your comments below. Thanks!

Impetigo – Appotek

Impetigo is a common and contagious skin disease that most commonly affects children, especially those between 2 and 5 years of age. This affects the outer layers of the skin, which leads to the appearance of red blisters on the face, arms and legs. Impetigo tends to be seasonal, peaking in summer in northern climates. In warm and humid climates, it is found all year round. Impetigo is treated with antibiotics and symptoms usually disappear within a few weeks.

APPOTEK can help you with impetigo.

Causes

Impetigo is a skin infection usually caused by the bacteria Staphylococcus aureus or Streptococcus pyogenes . These bacteria infect the outer layers of the skin, called the epidermis. Most often, impetigo is localized on the face, behind the ears, on the arms and legs.

Blisters are contagious – impetigo can be spread through direct contact with someone who is infected or by touching something that the person with impetigo has touched. Impetigo can also be spread through water baths. If you have eczema or skin irritation, you are more likely to get infected.

Symptoms

Impetigo can manifest differently in different people. Some have only irritation and redness of the skin; others develop red blisters that break open to form honey-colored crusts.

Typically, blisters first appear as small red dots and then turn into fluid-filled, itchy blisters. They burst, dry out and form yellowish-brown crusts. The most common site for impetigo is the face (behind the ears, around the nose or mouth), but blisters can also appear on other parts of the body.

Wounds may itch and sometimes be painful. After the crusts pass, they leave red marks that disappear without leaving scars.

Infection often occurs at small cuts, insect bites, or rashes such as eczema where the skin is broken. But impetigo can also occur on healthy skin. This is called primary impetigo, and secondary impetigo occurs on damaged skin.

Babies sometimes have a more localized form of impetigo, with large blisters in the diaper area or skin folds. The fluid-filled blisters soon burst, leaving a scaly rim.

Impetigo can be uncomfortable. Sometimes, regional lymph nodes may enlarge or the temperature may rise.

Prevention and protection

Blisters are contagious when wet. Therefore, it is important to perform the following procedure 4 times a day :

  1. Wash the blisters with soap and water – when they are soaked and you can remove them.
  2. Then wash them with plenty of chlorhexidine solution and allow them to air dry.
  3. Lubricate blisters with mupirocin ointment.

How to avoid spreading infection:

  • wash/disinfect your hands frequently
  • use paper towels to dry your hands
  • change bed linen daily and towels after every shower
  • wash clothes every day (and toys if you have children)
  • Keep your door handles clean.

Impetigo in children: children should stay at home and not go to school until the blisters are completely dry. Remember that toys and clothes can be contagious.

Treatment

Impetigo is usually treated with antibiotics. The type of antibiotic depends on how common the blisters are.

If you only have impetigo on a small area of ​​your skin, topical antibiotics are the treatment of choice. These include mupirocin and retapamulin cream or ointment.

If your impetigo is severe or widespread, your doctor may prescribe oral antibiotics. They may work faster than topical antibiotics, but are not necessarily better for infections. Oral antibiotics can also cause more side effects than topical antibiotics, such as nausea.

After treatment, impetigo usually resolves in 7-10 days. If you have an underlying skin condition, the infection may take longer to heal. It is important to remember to practice good hygiene and always keep wounds clean and covered during treatment until complete recovery to prevent infecting others.

When to see a doctor

It is recommended that you see a doctor if you suspect you have impetigo, they can usually diagnose the infection by its appearance.

If blisters persist after treatment, culture may be required. It involves taking a small amount of fluid that comes out of the wound and testing it to determine what type of bacteria caused the infection and what antibiotics would be effective against it.

If you have impetigo with general weakness and high fever, you should contact your doctor immediately. This also applies to frequent, recurring infections.

How APPOTEK can help you

APPOTEK can help you with impetigo. During the video consultation, the doctor will evaluate your symptoms. You may then be given treatment or be referred for further testing.

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What is impetigo and how does it look like?

Impetigo is a common skin infection transmitted by direct contact with rashes. The disease is most common in children, but it can also appear at a later age.

The peak of incidence occurs in summer and autumn; warm and humid climate favors the spread 2 . The disease is contagious and is transmitted during direct contact with the skin of a sick person.

Often, outbreaks occur within families or in places of close contact, such as kindergartens or the military.

People with diabetes or a weakened immune system (eg after chemotherapy) are also prone to impetigo.

Impetigo causative agents

Impetigo is usually caused by one of two types of bacteria or a combination of them:

  • Staphylococcal impetigo
  • Streptococcal impetigo
  • Streptostaphylococcal impetigo

At present, the most frequently detected pathogen is Staphylococcus aureus (S. aureus) 1 , some species of which, for example, methicillin-resistant aureus staphylococcus aureus are resistant to many antibiotics.

Types of impetigo

Primary impetigo

In primary impetigo, the infection affects the healthy layers of the skin.

Secondary impetigo

Secondary impetigo occurs when an infection attaches to an existing disease.

For example , areas affected by eczema or psoriasis, as well as damaged skin, may develop secondary impetigo. Children infected with scabies are 12 times more likely to develop impetigo than children with healthy skin.

Also classified as non-bullous, bullous
(blistering) or ecthyma (ulcerative impetigo) 4.11 .

Non-bullous impetigo

Non-bullous impetigo is the most common form of the disease caused by Staphylococcus aureus and/or group A beta-hemolytic streptococcus, accounting for 70-80% of cases 2, 3 .

The rash usually appears 4-10 days after infection. At first, small fluid blisters form on the skin, which often go unnoticed as they quickly burst, leaving scab-like patches on the skin. Sometimes only one blister may appear, which is a moist golden crust on the skin, under which inflammation develops.

It happens that the affected areas simply look reddened and inflamed, as the crusts are removed or combed.

Impetigo most often affects the face, but can also occur on other areas of the skin. The size of the lesions varies, but they are usually quite small – about a centimeter at the onset of the disease. In the future, impetigo may grow, with smaller spots forming around the first spot.

Bullous impetigo

Bullous impetigo is almost always caused by Staphylococcus aureus 2 .

This type of impetigo is characterized by the presence of large bullae. The skin at the top of such a blister is very thin and easily damaged, it bursts, leaving large red irritated spots.

Impetigo may occur on the face, arms, legs, or buttocks. It is most likely to appear on skin already affected by other diseases (for example, in areas with eczema).

Ecthyma

This is a less common type of impetigo that causes sores on the skin.

Diagnosis of impetigo

The diagnosis is made by a dermatologist on the basis of anamnesis, visual examination and various research methods 2. 9 :

  • Visual examination allows you to see the microstructure of the skin in detail.
  • Microscopic examination. Used to determine the type of pathogen and form of impetigo.
  • Clinical blood test. Allows you to identify the presence of common diseases associated with the occurrence of impetigo.
  • Microscopy of smears of discharge from the affected areas is necessary to identify the pathogen and confirm the diagnosis.
  • Bacterial inoculation consists in the fact that the discharge from the affected areas is “sown” on special nutrient media, on which microorganisms actively grow and multiply. Sowing allows not only to identify the pathogen, but also to analyze the reaction of bacteria to various antimicrobial drugs. Most often, this research method is used for suspected methicillin-resistant (methicillin-resistant) staphylococcus aureus (MRSA) or when investigating an outbreak of impetigo in any group.

How is impetigo treated?

The goal of treatment is to eliminate the soreness caused by lesions, unaesthetic manifestations of the disease (especially on the face), and to prevent the spread of infection or the development of complications.

As a rule, impetigo is treated with local remedies – ointments, creams, solutions. However, in some cases antibiotic treatment is indicated. This includes the following situations:

  • The rash affects large areas of the body.
  • Infection continues to spread despite topical treatment.
  • The infection returns after the end of treatment.
  • Reduced immunity.
  • General malaise due to high fever and sore throat.

    In such cases, oral (by mouth) antibiotics are indicated for 7 days. The selection of an antimicrobial drug is carried out by a doctor, based on many factors in a particular patient (pathogen sensitivity, allergic reactions, etc.).

    Taking antibacterial drugs does not exclude topical antiseptic treatment, for example, with a solution of povidone-iodine.

Povidone iodine

Characteristics and properties of povidone iodine. What is povidone-iodine used for? Instructions for use of the solution, ointment, suppositories Betadine ® with povidone-iodine.

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Topical treatment of impetigo

Uncomplicated forms of impetigo respond well to topical treatment.

Treatment options for impetigo include the following ointments and creams:

  • Keratolytic ointments based on sulfur, salicylic acid. Used to soften and partially dissolve the stratum corneum of the skin.
  • Topical disinfectants – povidone-iodine and chlorhexidine, hexachlorophene.
    Used to decontaminate damaged areas of the skin.
  • Antibacterial ointments/creams – eg neomycin, bacitracin, polymyxin B, gentamicin, fusidic acid, mupirocin, retapamulin.
  • Combination corticosteroid ointments/creams (combination of steroids and antibiotics) – betamethasone + gentamicin, hydrocortisone + neomycin + netamycin, betamethasone + fusidic acid. Used to reduce inflammation and eliminate severe itching.

At the time of treatment, it is recommended to refrain from visiting public places and contact with other people for at least 24-48 hours. In addition, it is forbidden to wash the affected areas. The skin around the foci must be wiped with antiseptic preparations. The nails are cut short, the subungual folds are smeared with an iodine solution, for example, povidone-iodine (Betadine ® ) 4.5 .

The use of topical antimicrobials in the treatment of impetigo can greatly facilitate the healing process of lesions. Antiseptics have a wide spectrum of activity against bacteria, fungi and viruses, so they are well suited for the treatment of various skin lesions and related complications.

Treatment of impetigo with iodine preparations (Betadine®)

Preparations based on povidone-iodine ( Betadine ® ) have a wide spectrum of antimicrobial activity, are active against gram-positive bacteria (staphylococci and streptococci), gram-negative bacteria, fungi and viruses 7. 8 .

In addition, povidone-iodine ( Betadine ® ) is active in vitro against biofilms formed by P. microorganisms. A protective “dome” is created in the biofilm, which reduces the effectiveness of both drugs and human antimicrobial immune cells. Therefore, wounds heal slowly, and the infection does not go away.

To date, there is no evidence that pathogens can be resistant to povidone-iodine, making it a key advantage in an era when resistance to antiseptics and antibiotics is steadily increasing 6 .

Preparations Betadine ® , unlike alcohol solutions of iodine and brilliant green, do not cause burning and persistent skin coloration, which is especially important when treating affected areas in children and adults.

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Prevention of impetigo

Since impetigo is a contagious disease, the following guidelines should be followed 2 :

  • Try to avoid contact with the rash.
  • Wash hands immediately after contact with rashes and after handling skin and applying ointment.
  • Use individual towels and other hygiene products until the infection is completely eradicated.
  • Children who become ill should not attend educational institutions, and adults should remain on sick leave until the skin is completely clear or at least for at least 48 hours after starting antibiotic therapy.
  • If impetigo recurs, screening for causative bacteria should be carried out.

Frequently Asked Questions

What if the treatment doesn’t work?

Be sure to tell your doctor if the prescribed treatment does not help. One of the possible reasons may be the resistance of bacteria to prescribed drugs, in which case a change of antibiotic is necessary. In some cases, it is recommended to take a scraping to identify the causative agent of the infection and choose the optimal treatment regimen.

What diseases have similar symptoms to impetigo?

Impetigo is often confused with another skin disease, panniculitis, which is a lesion of the deeper layers of the skin. Compared to impetigo, panniculitis has a much larger area of ​​skin involvement, swelling and redness, and no blisters or crusts. Panniculitis requires immediate treatment, especially when it comes to the skin of the face and the area around the eyes.

An impetigo rash near the lips is also often mistaken for a “cold” on the lips, which is a manifestation of a viral infection and can recur in the same place.

Why does impetigo reappear?

Children often have one or two episodes of impetigo. However, some people may suffer from constant relapses. One of the reasons is the presence in the body of the corresponding bacteria, for example, in the nasopharynx. In general, they do not harm health, but can spread over the face and provoke impetigo. If the doctor suspects the presence of bacteria in the body, he may take a swab from the nasopharynx for examination and subsequently prescribe a course of antibiotics.

Which doctor treats impetigo?

Since impetigo is a skin disease, the treating doctor is undoubtedly a dermatologist. Also, in the presence of concomitant diseases and for the correction of treatment, you will need to consult a pediatrician or therapist, depending on the age of the patient.

Tamrazova Olga Borisovna

MD, Professor of the Russian Academy of Sciences, Professor of the Department of Dermatovenereology with a Course in Cosmetology of the FNMO of the Medical Institute of the FGAEI VO RUDN University of the Ministry of Science and Higher Education of the Russian Federation, Moscow.

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References

  1. Pereira LB. Impetigo review. An Bras Dermatol. 2014;89(2):293-299. doi:10.1590/abd1806-4841.20142283.
  2. Nardi NM, Schaefer TJ, Espil MO. Impetigo (Nursing). In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 11, 2021.
  3. Abrha S, Tesfaye W, Thomas J. Intolerable Burden of Impetigo in Endemic Settings: A Review of the Current State of Play and Future Directions for Alternative Treatments. Antibiotics (Basel). 2020;9(12):909. Published 2020 Dec 15. doi:10.3390/antibiotics9120909.
  4. Koning S, van der Sande R, Verhagen AP, et al. interventions for impetigo. Cochrane Database Syst Rev. 2012;1(1):CD003261. Published 2012 Jan 18.
  5. Kashutin S.L. Dermatovenereology.// Textbook//Northern State Medical University, 2015. Arkhangelsk.
  6. Barreto R, Barrois B, Lambert J, Malhotra-Kumar S, Santos-Fernandes V, Monstrey S. Addressing the challenges in antisepsis: focus on povidone iodine.