Sometimes referred to as a rash by parents, impetigo is bacterial infection of the skin that is contagious. Quite often children arriving from orphanages or entering foster care are plagued by these infections. This is probably due to poor sanitation, close and overcrowded living quarters, poor diet, and lack of medical care. The two most common forms of bacteria that are responsible for impetigo are streptococcus and staphylococcus bacteria. Streptococcus bacteria are also responsible for strep throat and scarlet fever.

Young children and infants are more likely to be plagued by impetigo. This is because they are more susceptible to colds, then they put their fingers in their noses and spread bacteria to the other children. They are also prone to frequent small cuts, scrapes, and insect bites that allow bacteria to get in. Patches of eczema as well as areas of skin chronically covered by hot, wet clothes such as diapers or bibs can allow bacteria to enter and may result in infection.

Healthy skin is a powerful barrier that is remarkably resistant to infection. It keeps bacteria outside of your child’s body. The outer layer of skin is made of the same material as a rhinoceros’s horn. This thin flexible armor is called the stratum corneum. The stratum corneum is constantly moving the bacteria out of the body by growing new layers and shedding old layers. Unfortunately, it is only completely resistant when dry.

Impetigo may exist with blisters called bullous impetigo or without blisters called nonbullous impetigo. Staphylococcus bacteria usually are the cause of bullous impetigo. These blisters filled with fluid may form in the diaper area, or anywhere else on the body. The blisters leak and break easily leaving a raw, moist sore that may form a scab.

Nonbullous impetigo usually occurs near the nose, mouth, or ears, however it can be anywhere on the body. A small red patch or a pimple usually appears and then spreads to a larger crusted sore. The infection can spread by towels, clothes, fingers, or under the skin and pop up at distant sites. It sometimes itches and may be accompanied by swollen glands

Because Impetigo can be spread by touch and shared objects, it is quite contagious until the rash disappears or antibiotics have treated it for two days with obvious improvement. However, the bacteria cannot enter someone’s intact, healthy skin.

Both types of impetigo respond well to treatment. Treatment usually last for up to 10 days. Washing can help prevent the spread and reoccurrence of impetigo. Bacteria live under yellow-brown scabs so they should be removed to allow topical antibiotics to work by soaking them in warm water. Oral antibiotics are a faster and more reliable therapy in stubborn cases of impetigo.

Unfortunately, we all know of orphanages that do not have running water. Even if they do have water they are frequently overcrowded and understaffed which doesn’t allow for proper hygiene, cleaning, or laundry. Children who enter the foster care system commonly lack proper hygiene skills. Typically, their homes and laundry were not properly cleaned either. All of these children usually lack proper nutrition as well, not allowing them to have healthy skin and healthy immune systems making this a common malady for new adoptive parents to deal with.

Photo Credit 1994 Julia Fuller