What is the treatment for impetigo (a contagious skin infection) superimposed on herpes simplex (a viral infection caused by the Herpes Simplex Virus (HSV)) on the nose?

From the Guidelines

For treating impetigo on top of herpes simplex on the nose, a dual approach is needed to address both infections, starting with oral antibiotics such as cephalexin or dicloxacillin to treat the bacterial impetigo, and simultaneously using oral antiviral medication like acyclovir, valacyclovir, or famciclovir to treat the underlying herpes infection. This combined approach is necessary because impetigo is a bacterial infection caused by Staphylococcus or Streptococcus that has superimposed on the viral herpes lesion, requiring both antibacterial and antiviral treatments for complete resolution 1.

Treatment Approach

• Oral antibiotics: cephalexin (500 mg four times daily for 7-10 days) or dicloxacillin (500 mg four times daily for 7-10 days) to treat the bacterial impetigo, as recommended by the Infectious Diseases Society of America 1.
• Oral antiviral medication: acyclovir (400 mg five times daily for 7-10 days), valacyclovir (1 gram twice daily for 7-10 days), or famciclovir (250 mg three times daily for 7-10 days) to treat the underlying herpes infection, with valacyclovir being a suitable option for prophylaxis in patients with frequent recurrent attacks 1.
• Topical treatment: topical mupirocin ointment (apply three times daily for 7-10 days) can help with the impetigo, as it is effective against Staphylococcus aureus and Streptococcus pyogenes 1.

Additional Measures

• Keep the area clean with gentle washing using antibacterial soap and warm water twice daily.
• Avoid touching or picking at the lesions to prevent spreading the infections.
• Use separate towels and washcloths to prevent transmission of the infection.
• If symptoms worsen or don't improve within 3-4 days of treatment, seek medical attention as more aggressive therapy may be needed.

From the FDA Drug Label

The efficacy of topical mupirocin ointment in impetigo was tested in two studies. Clinical efficacy rates at end of therapy in the evaluable populations (adults and pediatric patients included) were 71% for mupirocin ointment (n=49) and 35% for vehicle placebo (n=51). Pathogen eradication rates in the evaluable populations were 94% for mupirocin ointment and 62% for vehicle placebo Double-blind, placebo-controlled studies have demonstrated that orally administered acyclovir significantly reduced the duration of acute infection and duration of lesion healing.

The treatment for impetigo superimposed on herpes simplex on the nose may involve a combination of:

• Topical mupirocin ointment for the treatment of impetigo, as it has been shown to be effective in clinical studies 2
• Oral acyclovir for the treatment of herpes simplex, as it has been shown to reduce the duration of acute infection and duration of lesion healing 3 It is essential to note that the treatment should be guided by a healthcare professional, and the specific treatment regimen may vary depending on the individual case.

From the Research

Treatment Options for Impetigo Superimposed on Herpes Simplex

• The treatment for impetigo, a contagious skin infection, typically involves the use of topical or oral antibiotics, depending on the severity of the infection 4, 5.
• For impetigo superimposed on herpes simplex, a viral infection caused by the Herpes Simplex Virus (HSV), the treatment approach may need to consider both the bacterial and viral components of the infection.
• Topical antibiotics such as mupirocin have been shown to be effective in treating impetigo, with clinical improvement seen in 85% to 100% of patients within 3 to 5 days 6, 7.
• Other topical treatment options for impetigo include fusidic acid, retapamulin, and ozenoxacin 1% cream, which have been shown to be effective and safe in treating impetigo 4, 8.
• Oral antibiotics such as erythromycin, penicillin, and amoxicillin/clavulanate may also be considered for more severe cases of impetigo or for patients with extensive disease 4, 5.

Considerations for Treatment

• The choice of treatment for impetigo superimposed on herpes simplex should take into account the potential for antimicrobial resistance, particularly in cases where methicillin-resistant Staphylococcus aureus (MRSA) is suspected 8.
• The treatment regimen should also consider the patient's age, severity of symptoms, and potential for transmission to others 4, 5.
• Topical treatment options may be preferred for mild to moderate cases of impetigo, while oral antibiotics may be necessary for more severe cases or for patients with underlying medical conditions 4, 5.