What is the treatment for impetigo (infectious skin disease) on the lips?

From the Guidelines

Impetigo on the lips should be treated with topical mupirocin or retapamulin twice daily for 5 days for mild cases, as recommended by the Infectious Diseases Society of America 1. For more extensive infections, oral antibiotics such as cephalexin or clindamycin for 7 days may be necessary 2. Key considerations in treatment include:

• The causative bacteria, typically Staphylococcus aureus or Streptococcus pyogenes, which can be identified through gram stain and culture, although treatment without these studies is reasonable in typical cases 1
• The potential for methicillin resistance in S. aureus isolates, which may require alternative antibiotics such as doxycycline, clindamycin, or sulfamethoxazole-trimethoprim 2
• The importance of preventing spread through good hygiene practices, including avoiding touching or picking at the sores, using separate towels and washcloths, and washing hands frequently Symptoms of impetigo on the lips include red sores that quickly rupture, ooze fluid, and form honey-colored crusts, and if left untreated, the infection can spread to other body parts or to other people through direct contact 1. If symptoms worsen or don't improve within 3-4 days of treatment, it is essential to seek medical attention as stronger antibiotics may be needed 1, 2.

From the FDA Drug Label

INDICATIONS AND USAGE Mupirocin ointment, 2% is indicated for the topical treatment of impetigo due to: Staphylococcus aureus and Streptococcus pyogenes. The treatment of impetigo with mupirocin ointment, 2% is indicated, but the label does not specify if it is suitable for impetigo on the lips.

• The label does not provide information on the use of mupirocin ointment on the lips.
• No conclusion can be drawn about the use of mupirocin ointment for impetigo on the lips based on the provided information 3.

From the Research

Impetigo on Lips

• Impetigo is a common bacterial skin infection that can affect various parts of the body, including the face and lips 4.
• The infection is usually caused by Staphylococcus aureus or Streptococcus pyogenes, and is characterized by honey-colored crusts on the affected area 4.
• Impetigo on the lips can be treated with topical antibiotics such as mupirocin, retapamulin, and fusidic acid 4, 5, 6.
• Topical mupirocin has been shown to be effective in treating impetigo, including cases caused by methicillin-resistant S. aureus (MRSA) 5, 6.
• Oral antibiotic therapy may also be used to treat impetigo, especially in cases with large bullae or when topical therapy is impractical 4.
• A comparative review of topical antibiotics for impetigo found that mupirocin, retapamulin, and fusidic acid are effective treatments, with minimal adverse events 6.
• The choice of topical antibiotic may depend on factors such as cost, insurance coverage, and the presence of MRSA or other resistant bacteria 6.

Treatment Options

• Topical antibiotics:
  • Mupirocin: effective against MRSA, but a bacterial culture is recommended to rule out resistance 6.
  • Retapamulin: effective against MSSA and streptococcus S. pyogenes, but not MRSA 6.
  • Fusidic acid: available in other countries, but rising resistance rates are a growing concern 6.
• Oral antibiotics:
  • Amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides are options, but penicillin is not recommended 4.

Efficacy and Safety

• Topical antibiotics have been shown to be effective in treating impetigo, with minimal adverse events 5, 7, 6.
• A systematic review of 68 trials found that topical antibiotic treatment showed better cure rates than placebo, and that mupirocin and fusidic acid were equally effective 7.
• Adverse events were minimal, with the most common being pruritus at the application site 6.