eMedicine Specialties > Emergency Medicine > Infectious Diseases

Impetigo: Follow-up

Author: Rashid M Rashid, MD, PhD, Resident Physician, Department of Dermatology, MD Anderson Cancer Center, University of Texas and The Morzak Center
Coauthor(s): Andrew C Miller, MD, Chief Resident and Clinical Assistant Instructor, Departments of Emergency Medicine and Internal Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center; Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Contributor Information and Disclosures

Updated: Sep 15, 2009

Follow-up

Further Inpatient Care

  • Inpatient care is required for patients with impetigo who have widespread disease or for infants at risk of sepsis and/or dehydration due to skin loss.

Further Outpatient Care

  • A follow-up examination is required if lesions have not cleared in 7 days.

Transfer

  • Transfer care to a neonatologist for neonates with bullous impetigo.

Deterrence/Prevention

  • Avoid contact with infected persons.
  • Keep wounds clean.
  • Wash hands after contacting lesions or infected patients.

Complications

Prognosis

  • Beyond the neonatal period, patients who receive early and appropriate therapy have an excellent chance of recovery without scarring or complications.
  • Neonates have a much higher incidence of developing a more generalized infection and meningitis.
  • Impetigo lesions usually resolve completely in 7-10 days with treatment. Culture lesions to find resistant organisms if the lesions have not resolved within 7-10 days.
  • Antibiotic treatment will not prevent or halt glomerulonephritis.

Patient Education

  • Because of the contagious nature, children should not return to daycare or school before the lesions clear. 
  • Caretakers must know how to avoid infection. A history of poor hygiene and crowded living situations are common.
  • This infection is transmitted by direct contact and by fomites, including hygiene items, clothing, and toys.
  • For excellent patient education resources, visit eMedicine's Bacterial and Viral Infections Center and Skin, Hair, and Nails Center. Also, see eMedicine's patient education articles Impetigo, Skin Rashes in Children, and Antibiotics.

Miscellaneous

Medicolegal Pitfalls

  • Failure to use antibiotics with coverage against staphylococci may result in failure of treatment.
  • Failure to recognize signs of dehydration and treat appropriately may result in hypovolemic and/or septic shock.

Special Concerns

  • The incidence of poststreptococcal glomerulonephritis is not affected by the treatment of the infection in the index patient, but antibiotic treatment will limit the endemic nature by limiting its spread to other hosts.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Randy Park, MD, to the development and writing of this article.



More on Impetigo

Overview: Impetigo
Differential Diagnoses & Workup: Impetigo
Treatment & Medication: Impetigo
Follow-up: Impetigo
Multimedia: Impetigo
References
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References

  1. Sarabi K, Khachemoune A. Tinea capitis: a review. Dermatol Nurs. Dec 2007;19(6):525-9; quiz 530. [Medline].

  2. Popovich D, McAlhany A. Accurately diagnosing commonly misdiagnosed circular rashes. Dermatol Nurs. Aug 2008;20(4):294-300. [Medline].

  3. Allen CH, Patel B, Endom EE. Primary bacterial infections of the skin and soft tissues, changes in epidemiology and management. Clin Ped Emerg Med. 2004;5:246-255.

  4. Dagan R. Impetigo in childhood: changing epidemiology and new treatments. Pediatr Ann. Apr 1993;22(4):235-40. [Medline].

  5. Elsayed S, Laupland KB. Emerging gram-positive bacterial infections. Clin Lab Med. Sep 2004;24(3):587-603, v. [Medline].

  6. Epps RE. Impetigo in pediatrics. Cutis. May 2004;73(5 Suppl):25-6. [Medline].

  7. Leyden JJ. Review of mupirocin ointment in the treatment of impetigo. Clin Pediatr (Phila). Sep 1992;31(9):549-53. [Medline].

  8. Loffeld A, Davies P, Lewis A, Moss C. Seasonal occurrence of impetigo: a retrospective 8-year review (1996-2003). Clin Exp Dermatol. Sep 2005;30(5):512-4. [Medline].

  9. Luby S, Agboatwalla M, Schnell BM, Hoekstra RM, Rahbar MH, Keswick BH. The effect of antibacterial soap on impetigo incidence, Karachi, Pakistan. Am J Trop Med Hyg. Oct 2002;67(4):430-5. [Medline].

  10. Nishijim S, Ohshima S, Higashida T, Nakaya H, Kurokawa I. Antimicrobial resistance of Staphylococcus aureus isolated from impetigo patients between 1994 and 2000. Int J Dermatol. Jan 2003;42(1):23-5. [Medline].

  11. Oranje AP, Chosidow O, Sacchidanand S, et al. Topical retapamulin ointment, 1%, versus sodium fusidate ointment, 2%, for impetigo: a randomized, observer-blinded, noninferiority study. Dermatology. 2007;215(4):331-40. [Medline].

  12. Zetola N, Francis JS, Nuermberger EL, Bishai WR. Community-acquired meticillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infect Dis. May 2005;5(5):275-86. [Medline].

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Further Reading

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Contributor Information and Disclosures

Author

Rashid M Rashid, MD, PhD, Resident Physician, Department of Dermatology, MD Anderson Cancer Center, University of Texas and The Morzak Center
Rashid M Rashid, MD, PhD is a member of the following medical societies: American Academy of Dermatology, Council for Nail Disorders, Houston Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Andrew C Miller, MD, Chief Resident and Clinical Assistant Instructor, Departments of Emergency Medicine and Internal Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center
Andrew C Miller, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Physicians, American Medical Association, Emergency Medicine Residents Association, Islamic Medical Association of North America, Medical Society of the State of New York, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Eric M Kardon, MD, FACEP, Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center
Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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