Impetigo Treatment Options: Medication, Lifestyle Changes, and More

There are two types of impetigo:

• Nonbullous Impetigo This type accounts for 70 percent of cases, and it is caused by bacteria called Staphylococcus aureus, which causes staph infection, or Streptococcus pyogenes, which can also cause strep throat. With this type, impetigo presents as a honey-colored, crusty rash on the face and other parts of the body. Often, nonbullous impetigo appears around (but not inside) the mouths of children, says Vikash S. Oza, MD, a pediatric dermatologist at NYU Langone Health in New York City.
• Bullous Impetigo This is the less-common type of impetigo in adults, and it is caused strictly by Staphylococcus aureus. With this strain, you will likely see blisters in areas where skin rubs together on the body, such as an armpit.

  [2]

“Streptococci (strep) are the bacteria we typically think of as causing strep throat, but they can cause [other] infections as well. Staph, strep, and other different bacteria — they’re all over the place. They’re on doorknobs, elevator buttons, and on grocery carts. Generally, you get impetigo by touching something contaminated with bacteria and then touching your skin. You kind of transfer the bacteria,” Dr. Aivaz says.

Impetigo is treatable with medication; the type of medication you or your child will need depends on the severity of the infection.

Topical Medication for Mild Impetigo

• retapamulin (Altabax)
• fusidic acid
• ozenoxacin (Xepi)

  [6]

Oral Medication for Widespread or Severe Impetigo

If the topical treatments aren’t effective or if the impetigo has spread to other parts of the body, your doctor may decide it’s time for an oral antibiotic.

• amoxicillin and clavulanate (Augmentin)
• dicloxacillin (Dycill)
• cephalexin (Keflex)
• clindamycin (Cleocin)
• doxycycline (Vibramycin)
• trimethoprim and sulfamethoxazole (Bactrim)

Aivaz says that she generally prescribes a topical antibiotic for localized areas. If things don’t improve within 48 hours or if the outbreak is more widespread, the dermatologist will typically suggest an oral antibiotic.

Because impetigo is highly contagious, Aivaz also says that when it comes to children with many siblings, she often opts for an oral antibiotic. “I worry a little bit that one sibling will pass it to all the other ones, so I will prescribe something a little bit more aggressive at that point,” she says.

At-Home Care for Widespread or Continued Impetigo

Aivaz says that for some people, impetigo can be recurrent, especially in those with sensitive skin conditions.

“Not everybody who touches bacteria gets impetigo, and usually you are predisposed to it if you have some break in the skin barrier. Sometimes people have eczema, and that dry, cracked skin is a portal of entry for bacteria,” she notes.

Aivaz also shares that some people, especially those who work in healthcare settings, can asymptomatically carry staph in their anus, belly button, or nose. For those with recurrent impetigo, Aivaz suggests a mild bleach bath, especially for kids.

“I will have mom or dad do a one cup of bleach in an entire bathtub, and have the little kiddo splash around in it for 10 minutes — maybe once or twice a week. That will really help decrease the bacterial counts on the body and minimize the risk of getting impetigo,” says Aivaz.

However, if your impetigo has returned and worsened, Alexis Monique Javier, DO, a pediatrician with Children’s Memorial Hermann Pediatrics in Houston, says that you should return to your doctor.

“Someone should seek treatment if the skin shows signs of infection, such as redness, swelling, pain on contact, drainage such as honey-crusted lesions or pus-like liquid, and/or fever,” cautions Dr. Javier.

Should You or Your Child Stay Home During Treatment?

“Since impetigo is highly contagious, the child should avoid close contact with other children until the rash disappears or improves after two days on antibiotics,” says Javier.

Aivaz says that if the rash is localized and you can cover it with a Band-Aid or clothing, there’s no need to miss school or work.

Lifestyle Changes and Hygiene Recommendations

While children often pass impetigo to one another through touching, contact with another child who has impetigo doesn’t automatically mean the infection will pass between the children.

The goal is to contain the impetigo and prevent it from spreading to other parts of the body and to other family members in the household. That’s where good hygiene comes into play.

Stay On Top of Laundry

Be diligent about thoroughly cleaning towels and sheets, for instance, to reduce the risk of impetigo spreading, Dr. Oza says. Set the washer to use hot water, and dry the laundry on high heat, to kill as many germs as possible.

Keep Your Hands Clean

When dealing with impetigo, Javier says it is important to remember that keeping things clean and covered helps with healing and prevents spreading to others.

“Some things to keep in mind in addition to antibiotics are cleaning the affected area with soap and water, covering open wounds loosely to prevent further spread of the infection to other parts of the body, and avoiding scratching,” she says.

To keep the risk of infection and spread low, Javier also suggests:

• Keeping fingernails short to avoid further scratches.
• Not sharing towels or washcloths with someone who has an active infection.
• Washing hands well before and after applying topical antibiotics or touching any affected sores.

Reduce Risk Factors

Because impetigo tends to develop where the skin is broken, taking steps to heal the skin damage before bacteria can enter it is vital.