Impetigo
IMPETIGO
ELIGIBILITY:1 Non-bullous impetigo, for adults and children aged 1 year and over
EXCLUDE: Bullous impetigo, recurrent impetigo (defined as 2 or more episodes in the same year), pregnant individuals under 16 years
IMPETIGO is a common and highly contagious bacterial skin infection. It is not usually serious and often gets better within 10 days with treatment. However, the blisters and sores can be unpleasant and uncomfortable. It affects all age groups but is most common in young children.14,15 There are two types of impetigo:14,15
Non-bullous impetigo: Accounts for 70% of cases and is characterised by the appearance of red sores and blisters which burst easily and leave round oozing patches with yellow-brown crusts.
Bullous impetigo: Is characterised by fluid-filled lesions over 1cm in diameter. When they rupture, they ooze yellow fluid leaving a scaley rim. This is less common and would require further assessment.
Sally is collecting her regular prescription from the pharmacy and has brought her 5-year-old daughter Lily with her. Sally has been coming to the pharmacy for many years and is always friendly with the pharmacy team. As you chat with her, you notice that Lily has some red sores around her mouth and nose, some of which have burst and now have yellow crusts around them. She otherwise appears happy and healthy, but you think she may have impetigo.
Lily appears to have the following symptoms of impetigo:14,15
Red sores – usually around the nose and mouth but other areas of the face and limbs can be affected
Sores burst easily and leave behind thick, golden crusts around a weeping patch
Sores aren’t always painful, but they can be itchy
Spread to other parts of the body
Click the button to find out whether this customer is eligible for referral.
REFERRAL OUTCOME
Referred to the Pharmacy First service
You tell Sally:
"I notice that Lily has some sores and blisters around her mouth and I think it may be impetigo. We offer the Pharmacy First service which entails a consultation and assessment with the pharmacist where Lily can be seen and treated if eligible. Would this be of interest to you?"
Sally seems pleased with this as her GP surgery is very busy and she struggles to get an appointment there. The pharmacist leads them to the consultation room and Sally is given some antibiotic cream for Lily. She is very grateful that you spotted this as it saved her so much time! She wants to know what she should do as she doesn’t want her other children to get it.
PREVENTION TIPS
To prevent impetigo from spreading or getting worse while it’s still contagious, they should:14.15
Keep Lily away from school
Keep sores, blisters and crusty patches clean and dry
Wash hands frequently
Wash flannels, bedding and towels at a high temperature and avoid sharing them with others
Wash or wipe down toys with detergent and warm water
Avoid scratching or touching sores, blisters or crusty patches – this will also help prevent scarring
Avoid contact with people who are immunocompromised, e.g. those on chemotherapy
Avoid contact sports
If she develops them anywhere else on her body she should cover them with loose clothing or gauze bandages
Impetigo should stop being contagious 48 hours after using the antibiotic cream. Those who do not get treatment are not contagious after the patches dry out and crust over.
Complete the care
You remind Sally that Lily’s infection should clear up in a few days and reassure her that it’s very common in young children. You remind her how to use the cream and let her know that she should come back if she has any other concerns.
KEY LEARNING POINT
Recognising the key signs and symptoms of conditions like impetigo can help you identify potential customers that can benefit from the Pharmacy First service. This can save time, money and reduce the risk of complications with delayed treatment.