Posted on 02 Jun 2012 23:00
Impetigo is a contagious bacterial skin infection that is prevalent in children. Characterized by the eruption of yellowish-red (honey colored) pustules, it also affects athletes who are in frequent close contact with each other. It is common in wrestlers, boxers, swimmers, and gymnasts. Rugby players and football players may also be at high risk. The infection is commonly caused by Staphylococcus aureus bacteria, but also sometimes Staphylococcus pyogenes. The pustules may itch and burn and when they erupt, more pustules will be created. The areas most affected are the ones subject to high friction.
Infections such as impetigo are known as pyodermas, which are infections of the skin and related areas with pus producing microorganisms, usually Staphyloccocus. These infections are more common in children but there are predisposing factors, such as poor nutrition, poor hygiene and unsanitary conditions. Also, hot and humid environments can predispose people to pyodermal infections, so athletes are at particular risk.
The pustules of impetigo are typically superficial well-defined and crusted erythematous vesicles which occur on exposed areas of the face or extremities. These may be confused with tinea corporis, herpes simplex, or acne during early stages. The lesions most commonly occur around the mouth or nose, or at the site of skin trauma such as cuts or scrapes.
Impetigo starts as a small, distinct discolored area of the skin (macule) which turns into a fluid filled sac called a vesicle. The vesicle has a very thin roof which easily ruptures, letting the fluid ooze out to dry and form a thick, honey-colored crust with a slightly eroded area beneath it.
An athlete with impetigo should avoid contact with other athletes and with playing surfaces. Such contact will break the pustules and not only will this cause more pustules to erupt but it will spread the infection.
Impetigo around mouth
image by skindisorders3
The usual course of treatment is hydrogen peroxide, saline, or peremanganate cleansing to remove the bacteria, pus, and crusts from the skin. For milder infections, topical antibiotics alone should suffice, of antibacterial creams such as mupirocin (Bactroban, Centany). Other topicals that might be used include:
- Neomycin with bactracin and polymixin B. (the classic "triple-antibiotic ointment")
- Sisomicin (Ensamycin)
- Framycetin (Soframycin)
- Fusidic Acid (Fucidin leo skin cream)
- Nitrofurazone (Furacin)
Systemic (oral) antibiotics such as procaine penicillin, ampicillin, cloxacillin, erythromycin, or cephalexin may be required for more widespread or bulbous impetigo, or when there are signs of systemic infection. Systemic treatment may also be required when there are pyodermic outbreaks within a facility. Also, children may be better managed with systemics.4
With treatment the infection will usually resolve quickly and return to play should be possible after 5 days of antibiotic treatment, all the lesion's crusts have dried, and there have been no new lesions within the last 48 to 72 hours.
Along with the precautions above, it is not prudent to cover active lesions in order to be able to return to play as the lesions may burst and simply cause more lesions to form and risk spread of the infection to other players. Athletes with moist and crusted lesions should not be allowed to play. When bandages are used, they should be disposable. Reusable neoprene sleeves or elastic wraps can harbor the infection and transmit it to other players. After treatment, inactive lesions can be covered with a non-permeable covering during play.
Impetigo from MRSA
MRSA stands for Methicillin-Resistant Staphylococcus arueas. The abbreviation CA-MRSA is also sometimes used for Community-Acquired methicillin-Resistant Staphylococcus arueas. These types of infection, in the past, were only associated with hospitals but they are becoming more prominent in athletic settings. They are resistant to the commonly prescribed antibiotics from the penicillin and cephalosporin group, which are β-lactam antibiotics.
Impetigo of MRSA origin is possible and the early stages may appear similar to any staph skin infection. It a good idea to rule out MRSA in athletes with impetigo. A proper culture may allow the proper antibiotic to be chosen and hospitalization with IV antibiotics may be necessary for entrenched infections. CA-MRSA infections can progress to a much worse condition with large, inflamed, painful and hardened lesions. These infections can quickly spread throughout an athletic organization and cause a serious epidemic.1,2
Bulbous impetigo is Staphylococci impetigo which progresses rapidly to large, flaccid bulba which are caused by the release of epidemolytic toxins. When this occurs, it is usually in infants or young children.3
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