Can you get impetigo on your feet?

Impetigo on Feet

Yes, impetigo can definitely occur on the feet, as it commonly affects extremities including the feet, though it most frequently appears on the face. 1

Clinical Presentation of Impetigo on Feet

• Impetigo on feet presents in two main forms:

  • Nonbullous impetigo (70% of cases): Characterized by honey-colored crusts that begin as papules, evolve into vesicles surrounded by erythema, then become pustules that break down over 4-6 days 1, 2
  • Bullous impetigo (30% of cases): Appears as fragile, flaccid bullae filled with clear yellow fluid that later becomes darker and turbid 1, 2

• Ecthyma, a deeper ulcerated form of impetigo, may also occur on the feet and is characterized by circular, erythematous ulcers with adherent crusts 2

Causative Organisms

• Nonbullous impetigo is caused by Staphylococcus aureus or Streptococcus pyogenes (Group A streptococci), or both 2, 3
• Bullous impetigo is caused exclusively by toxin-producing strains of S. aureus 2, 3

Risk Factors for Foot Impetigo

• Minor trauma, abrasions, or insect bites that allow bacteria to enter the skin 1
• Poor hygiene conditions 1
• Pre-existing skin conditions such as athlete's foot (T. pedis) that create fissures between toes 1
• Macerated or fissured interdigital toe spaces that can harbor streptococci 1
• Warm, humid environments that promote bacterial growth 1

Treatment Options

For Limited Lesions on Feet:

• Topical mupirocin 2% ointment applied three times daily for 5-7 days 4, 2
• Retapamulin 1% ointment applied twice daily for 5 days 4, 3
• Fusidic acid as an alternative topical agent 3, 5

For Extensive Foot Lesions:

• Oral antibiotics are indicated when:

  • Impetigo is extensive or involves multiple sites
  • Topical therapy is impractical
  • Treatment with topical antibiotics has failed
  • Systemic symptoms are present 4, 2

• Recommended oral antibiotics:

  • For MSSA: Dicloxacillin, cephalexin (250-500 mg four times daily for adults) 4, 2
  • For MRSA: Clindamycin (300-450 mg three times daily), trimethoprim-sulfamethoxazole, or doxycycline (not for children under 8) 4, 2

Prevention Measures for Foot Impetigo

• Good personal hygiene and thorough drying between toes after showers 1
• Daily change of socks 1
• Treatment of underlying conditions like athlete's foot (T. pedis) 1
• Wearing rubber-soled flip-flops or sandals in communal showers 1
• Avoiding sharing towels and other personal items 1

Common Pitfalls and Caveats

• Penicillin alone is not effective for impetigo as it lacks adequate coverage against S. aureus 4, 6
• Failure to treat underlying conditions like athlete's foot can lead to recurrent impetigo 1
• Topical disinfectants are inferior to antibiotics and should not be used 3, 6
• If impetigo is not responding to appropriate therapy, consider alternative diagnoses or antibiotic resistance 4, 3
• Cultures should be obtained in cases of treatment failure, suspected MRSA, or recurrent infections 4, 2

Follow-up Recommendations

• Re-evaluate if no improvement after 48-72 hours of therapy 2
• Keep lesions covered with clean, dry bandages to prevent spread 4, 2
• Complete the full course of antibiotics even if symptoms improve quickly 2