Is impetigo painful?

Is Impetigo Painful?

Impetigo typically causes minimal to no pain, though patients may experience mild discomfort, itching, or burning sensations at the site of lesions. 1

Clinical Presentation and Symptoms

Impetigo presents in two main forms:

1. Nonbullous impetigo (70% of cases):

   • Characterized by honey-colored crusts on the face and extremities
   • Caused by Staphylococcus aureus or Streptococcus pyogenes
   • Begins as erythematous papules that rapidly evolve into vesicles and pustules that rupture
   • Dried discharge forms honey-colored crusts on an erythematous base 2, 1

2. Bullous impetigo (30% of cases):

   • Caused exclusively by toxin-producing strains of S. aureus
   • Results in large, flaccid bullae (fluid-filled vesicopustules)
   • These fragile lesions may rupture, creating crusted, erythematous erosions 2, 1

While pain is not a primary feature of impetigo, patients may experience:

• Mild discomfort
• Itching (pruritus)
• Burning sensation
• Regional lymphadenitis in some cases 1

Distinguishing Features from Painful Skin Conditions

It's important to distinguish impetigo from ecthyma, which is a deeper infection that:

• Can be caused by S. aureus and/or streptococci
• Presents as circular, erythematous ulcers with adherent crusts
• Is typically more painful than impetigo
• Heals with scarring (unlike impetigo which typically resolves without scarring) 2

Management Considerations

Treatment options include:

• Topical therapy (for limited disease):

  • Mupirocin or retapamulin twice daily for 5 days
  • Clinical efficacy rates for mupirocin are significantly higher (71-93%) compared to placebo (35%) 3, 1

• Systemic therapy (for extensive disease):

  • 7-day regimen with an agent active against S. aureus
  • Options include dicloxacillin or cephalexin for MSSA; doxycycline, clindamycin, or SMX-TMP for suspected MRSA 1
  • Penicillin alone is not effective for impetigo treatment 1

Important Clinical Considerations

• Impetigo is highly contagious and remains transmissible until 24 hours after starting appropriate antimicrobial therapy 1
• The condition typically resolves within 2-3 weeks without scarring 4
• Complications are rare but can include poststreptococcal glomerulonephritis 4
• Bacterial cultures should be obtained before initiating therapy to guide subsequent treatment, especially with rising rates of antibiotic resistance 1

Prevention and Control

• Maintain good hygiene practices
• Avoid sharing personal items
• Cover lesions with bandages
• Wash hands frequently
• Clean and disinfect surfaces
• Avoid close contact activities until 24 hours after starting treatment 1

For children in daycare or school settings, they should not return until at least 24 hours after beginning appropriate antimicrobial therapy 1.