A New Treatment for Impetigo

People who pop pimples often are punished by an even more disfiguring skin condition called impetigo. Entering the skin through tiny scratches, nicks, and tears, impetigo can spread all over the body and cause temporary disfigurement that’s a lot worse than acne. Scars and permanent disfigurement from impetigo, fortunately, are rare.

A Little Like Acne in the Beginning

The very first stages of impetigo look superficially a lot like acne. In the most common form of impetigo, the disease starts as a single macule, an area of reddened skin that is neither elevated above the general contour of the skin or indented below the general contour of the skin. Looking a little like a pimple that has been flattened out, this macule is usually between 5 and 10 mm (2/10 of an inch to a little under half an inch) across, larger than a pimple caused by acne but the same color.

The macule doesn’t stay that size very long. The skin that is infected with impetigo swells and bursts, releasing a honey-colored fluid that dries to a light brown. This fluid can carry infection all over the body, where the process of discoloration, swelling, and bursting is repeated over and over again.

Occasionally impetigo is first observed as a bulla (plural, bullae). The bulla is filled with clear fluid that bursts and spreads the infection all over the body. A burst bulla leaves a ring of tissue called a collarette, which may be all that is left of the lesion just 24 to 48 hours after it first appears. The bullous form of impetigo can also cause fever, diarrhea, and fatigue.

Both kinds of impetigo are worst where the skin is already broken. Impetigo can get into the skin where pimples have been popped or the skin has been rubbed raw by excessive cleansing. Unlike acne, impetigo can spread across the neck, chest, back, groins, arms, hands, legs, and feet.

Who Is At Risk for Impetigo?

Impetigo cases usually occur in clusters. Typically one child in a family gets the infection and quickly passes it on to siblings. Or one person who uses a locker room gets the infection and infects everyone in the gym. The spread of impetigo is faster in and on:

  • Hot and humid conditions,
  • Crowded living conditions,
  • Shared towels and wash cloths,
  • Shared clothing, and
  • Locker rooms, exercise equipment, school desks, school books, upholstery on seats in public vehicles, and work surfaces that are not properly sanitized.

Certain people are more likely to come down with impetigo, including:

  • Small children,
  • People in hospitals, nursing homes, and jails,
  • Diabetics,
  • People who have any condition that compromises immune function, such as HIV, and
  • People who receive medical treatments that compromise immune function, such as most cancer therapies, all steroid drugs, and most treatments for autoimmune disease.

What You Can Do to Prevent Impetigo Infection

The most important thing you can do to prevent the spread of impetigo is to make sure you don’t have skin-to-skin contact with another person who has impetigo. It is also important to wash clothing, bed linens, and towels used by someone who has impetigo on the hot cycle, to prevent the transmission of the disease. Wipe down or spray common surfaces when there is a possibility they are contaminated.

What to Do If You Come Down with Impetigo

Impetigo sometimes replaces an unsightly blackhead or pimple with an even more unsightly red, black, and blue skin wound. The most important thing you can do to if you come down with impetigo is to keep the infection from spreading from your face to the rest of your body.

How do you do that?

Bandaging bullae helps. Rinsing off the fluid released when impetigo bursts the skin with warm, soapy water does too. And it helps to use topical antibiotic ointments and creams. These products have the advantage of killing bacteria directly on the skin without any need to pass through the digestive tract. They cost less. They work faster. And they are easy to use.

The downside of topical antibiotics such as tetracycline and clinamycin, both of which are sometimes used to treat acne, is that they sometimes cause contact dermatitis—which can be still worse than either impetigo or acne. A new skin care product, however, may take care of this concern.

NVC-422 for Impetigo

Scientists at two institutions in the Dominican Republic, the Instituto DermatolĂłgico de Santo Domingo, and the Robert Reid Cabral Children’s Hospital in Santo Domingo have been experimenting with an entirely new approach to killing bacterial infections. The Dominican doctors use preparations of the amino acid taurine as “minimal bacteriocides” to kill just enough of the impetigo bacteria that the immune system can do the rest of the job.

The advantage of a minimalist approach to skin treatment is that there is far less risk of skin infection. The advantage of a new treatment is that there are no strains of staph or strep bacteria currently resistant to NVC-422, which will probably be on the market in the USA and Europe in 2015.

And What to Use in the Meantime?

While it’s definitely not the best choice, Neomycin is still the most commonly used treatment for impetigo world-wide. It’s better than nothing but sometimes it has no effect all. At the doctor’s office, you are more likely to be offered:

  • Mupirocin, which is sold under the trade name Bactroban. The downside of this medication is that is contains large amounts of propylene glycol, which can leak through the skin into the bloodstream if it is used on large areas of skin.
  • Retapamulin, which is sold under the trade name Altabax. Also a relatively new drug that has a new mode of action against bacteria, it can cause nose bleeds if it gets into the nose.
  • You might also be offered antihistamines, the same drugs used to treat allergies. These medications usually calm you and also stop itching and redness.

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