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Impetigo
Impetigo is a bacterial skin infection that is most common in young children. Typically, a few patches appear first on the face. They are often itchy and may have blisters and yellow crusts. Impetigo can spread quickly to other sites because scratching carries bacteria on the fingernails and breaks the skin surface, promoting infection. It also spreads between children. It is usually thought best to keep a child with impetigo home from school until the outbreak is fully under control.

Impetigo may develop as a complication of eczema. It can also develop in children who have no particular history of eczema, yet who develop patches of eczema beneath the infected crusts. This does not mean that they will go on to get eczema elsewhere, but probably means that they have a tendency to get irritant dermatitis.

For small areas of infection, treatment can be with an antibiotic ointment. Several are available on prescription. Those bought over the counter from the chemist are seldom sufficient. The ointment is best applied to the infected skin after the crusts have been removed. This can be combined with the use of an antiseptic washing agent or simply with soap and water. When infection is beyond one or two small patches, it may be necessary to take antibiotics by mouth.

Routine precautions in a family would be for children not to sleep in the same bed and for an infected child to have a separate wash cloth and towel. It may help prevent infection of school friends if children are kept at home until the crusts have settled and treatment is well established.

Impetigo usually settles within 7 to 10 days of effective treatment. There may be residual pink marks on the skin for several weeks after, but they eventually fade. If infections are recurrent, it is sometimes helpful to take swabs from family members and from the nose of the infected person, to see if there is a source of bacteria that accounts for the repeated infection. This is done by the GP or practice nurse.

Impetigo is caused by bacteria entering broken skin, giving rise to blistering and crusting of the skin.



Fungal infection
Fungal infection, such as ringworm, can easily be confused with eczema on any part of the skin. It may resemble gravitational eczema or seborrhoeic eczema. Fungal infec-tion is particularly common on the feet, where it usually causes irritation between the toes (athlete’s foot). Sometimes it may be helpful to take a skin scraping to rule out fungal skin infection before proceeding with eczema treat-ments. Skin scrapings are best done by someone with specific training in this technique. It might be your GP or practice nurse.

KEY POINTS
The epidermis is the top layer of the skin and where most damage is seen in eczema
Solvents such as excess water and soap are damaging to the epidermis
Scratching and rubbing contribute to the ‘itch–scratch cycle’, making eczema worse
When eczema oozes and leaves crust on the skin, it is often associated with bacterial infection
Rashes that come on suddenly may well be infection, or a reaction to infection
If a new rash affects several household members at the same time, it is more likely to be infection than eczema and all household members may need treatment depending on the diagnosis
Psoriasis can look like eczema but is rare in children and often has a silvery scale; it is more likely than eczema to affect the scalp