Your two-year-old has a runny nose for two weeks. You notice the skin under the nose becomes red and irritated. Two days later, the rash is worse, with thick crusty liquid oozing out. This sounds like impetigo.
It is a bacterial infection of the skin that can occur just about anywhere, but is most common around the mouth and nose or on the buttocks and arms. Impetigo may or may not itch. Scratching spreads the eruptions. Mild impetigo is often caused by streptococcus or staphylococcus. It occurs when the skin gets raw and irritated from scratching, runny nose, or excessive drooling. The bacteria may invade any area where the top protective layer of skin is broken down by an injury or irritation. Picking the skin around the nose or picking a pimple is an invitation for bacteria to come in and set up an infection.
It begins as tiny red spots, (resembling picked-at pimples) which become blisters that rupture and produce an oozing, sticky honey-colored crust on the surface. The spots are circular and may be as small as a dime or as large as a quarter. Impetigo is particularly common around the entrance to the nose, where the skin around the nostrils appears raw and reddened with a yellow crust.
Impetigo is not as contagious as it’s sometimes made out to be. You do not have to treat your child like a leper if he has impetigo. It can be transmitted by touching the eruptions, so it is important to tell your child not to touch the rash. Although, it’s common to find impetigo in several family members at once, it is rarely necessary to keep the child with impetigo out of school.
For impetigo that seems mild and is just beginning, follow these steps three times a day:
- Cut your child’s fingernails to help prevent trauma to the skin from scratching.
- Wash the infected area with warm soapy water.
- Apply some diluted hydrogen peroxide (mix ½ water with ½ peroxide).
- Wash off the peroxide after two minutes.
- Apply any over-the-counter antibiotic ointment such as polysporin.
- It may take one or two days for the infection to improve on this regimen. As long as it does not worsen then you should be fine.
If the infection continues to worsen despite the above treatment, then proceed with the following steps three times a day:
- Wash with warm soapy water.
- Apply a hot washcloth to the area for 10 minutes (this will improve blood flow to the area and help the body fight the infection).
- Apply diluted hydrogen peroxide, than wash off after two minutes.
- Apply 10% diluted Betadine solution (mix 1 tablespoon of this over-the-counter brownish red antiseptic with 10 tablespoons of water) and let it dry for two minutes.
- Thoroughly wash off all Betadine.
- Apply a prescription antibiotic ointment called Bactroban. Your doctor may call in this prescription for you. It may take one or two days for this treatment to start to improve the infection, but it should not keep getting worse during this treatment.
If you need the prescription ointment Bactroban, call or see your doctor. This generally would not warrant an urgent page to the doctor. If your doctor’s office does not open for another day or two, then a call to your doctor for the ointment is probably warranted.
More serious infection. If the redness and drainage continue to worsen despite all the above treatment, or your child develops fevers or red streaks extending out from the area, then you should see your doctor right away. If it is after hours, you should page your doctor. Your child may need oral antibiotics to help fight the infection.
- Prevent chapped lips. If your child is prone to dry, cracked lips, then routinely apply Vaseline lip therapy or Lansinoh to the lips (a Lanolin ointment is available in the diaper cream section of your local drug store).
- Treat sore noses during a cold. Apply Vaseline or Lansinoh to the irritated, cracked skin around the nose during a cold.
- Heal irritated patches around the mouth. If your child gets raw, irritated patches around the mouth, apply Vaseline or Lansinoh to heal it.