Impetigo

Condition

School sores” — a contagious superficial bacterial skin infection caused by Streptococcus pyogenes or Staphylococcus aureus, or a combination of the two. Characterised by pustules and honey-coloured crusted erosions. Most common in children (especially boys), but can affect adults with low immunity to the causative bacteria.

Two common forms: non-bullous (either S. pyogenes or S. aureus) and bullous (usually S. aureus).

Treatment

Mild, small lesions, limited area:

• Cleanse the wound; use moist soaks to gently remove crusts.
• Antiseptic (povidone-iodine, chlorhexidine) or mupirocin (Bactroban), a small amount three times daily for 5 days — topical antibiotics other than mupirocin 2% are not recommended.
• General measures while still oozing/crusted: cover the sores; avoid close contact with others (especially touch and bathing contact); regular hand washing; use separate towels and cloths; change and launder clothes/linen daily. Children must stay away from school until crusts have dried, or for 24 hours after starting oral antibiotics.

Extensive disease with systemic symptoms:

• Flucloxacillin/dicloxacillin 12.5mg/kg (up to 500mg) four times daily for 7 days, or
• Cephalexin 25mg/kg (up to 1g) twice daily, or 500mg four times daily, for 7 days, or
• Trimethoprim/sulfamethoxazole 160/800mg twice daily for 3 days.