Should You Cover Impetigo Spots?
Yes, covering impetigo lesions is recommended to help decrease transmission of infection, particularly in outbreak settings or when patients have numerous lesions.
Rationale for Covering Impetigo Lesions
While the IDSA guidelines 1 do not explicitly mandate covering impetigo lesions in all cases, they emphasize that systemic therapy is preferred for patients with numerous lesions or in outbreaks affecting several people specifically to help decrease transmission of infection 1. This transmission-reduction principle logically extends to covering lesions as a barrier method.
When Covering is Most Important:
- Outbreak situations where multiple people are affected
- Patients with numerous lesions (more than 10 lesions or >36 cm² affected area) 2
- School or work settings where close contact with others occurs
- Until 12-24 hours after initiating antibiotic treatment or clinical improvement occurs 3
Practical Approach to Covering
If you choose to cover impetigo lesions:
- Use non-adhesive dressings to avoid additional skin trauma
- Apply a simple dry dressing over the lesions
- Avoid adhesive dressings that could cause medical adhesive-related skin injury (MARSI), particularly in elderly patients or those with fragile skin 4
- Change dressings as needed to maintain cleanliness
Important Caveats
The primary treatment for impetigo is antimicrobial therapy, not dressing management. The IDSA guidelines 1 clearly prioritize:
- Topical antibiotics (mupirocin or retapamulin twice daily for 5 days) for localized disease
- Oral antibiotics (dicloxacillin or cephalexin for 7 days) for widespread disease, ecthyma, or when topical therapy fails
Covering lesions is an adjunctive infection control measure, not a substitute for appropriate antibiotic treatment.
Additional Infection Control Measures
Beyond covering lesions, emphasize 3:
- Good hand hygiene for the patient and caregivers
- Thoroughly washing objects used by the infected person
- Refraining from work/school until 12-24 hours after starting antibiotics or until clinical improvement
- Avoiding sharing towels, clothing, or personal items
The decision to cover should balance infection control benefits against practical considerations, but in communal settings or with multiple lesions, covering is the prudent approach to minimize spread to others.