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Impetigo: How can you make it clear up quicker?

Last Update: December 11, 2009.

Photo of child scratching
For less extensive infections with impetigo, the evidence shows that particular antibiotic ointments are effective.

Impetigo (impetigo contagiosa) is an itchy and sometimes painful skin infection. It is common, especially in young children. About 1 in 50 children in European countries get medical attention for impetigo (2%). The condition typically causes sores that form yellow-ish scabs, mostly on the face, arms or legs. The scabs dry up and fall off without leaving permanent scars.

The infection is caused by bacteria and is easily spread to other people. It can take a few weeks till it goes away by itself. Treatment might be needed if the infection looks bad, the skin is very itchy or if it is important to stop the infection spreading.

Research results

To compare the effectiveness of different treatment options, researchers from the Cochrane Collaboration (an international network of researchers) gathered and systematically assessed all the relevant trials. This showed that worldwide there are at least 36 different options for treating impetigo.

Although the researchers found 57 trials involving more than 3,500 people with impetigo, no single form of treatment has been really thoroughly tested. The trials looked at a lot of different options, but none of them produced results that were clear enough to be able to say for sure that one treatment is better than others.

For infections that are not very extensive, the research shows that antibiotic ointments with fusidic acid or mupirocin can help. It also appears that some antibiotic tablets might be able to help relieve impetigo. They probably have more adverse effects than ointments though. Oral antibiotics are usually only used in children who have very extensive infections, because using large amounts of ointment for days is not very practical. All of these antibiotic treatments are only available on prescription by a doctor.

As a first treatment option, disinfectant lotions or ointments that do not have antibiotics are often suggested. However, the evidence suggests these might not be effective.

In March 2009 we looked for recent research on impetigo treatments because we wanted to update this research summary. We found three newly published trials involving more than 500 participants in total. But the results of these trials did not change the general conclusions that can be drawn from research. One trial tested a new antibiotic ointment based on the active ingredient retapamulin which has been on the German market since 2007. The trial showed that it is probably more effective than a placebo (fake treatment), but also has more adverse effects, including itching, tingling or numbness.

It is still too soon to say whether the new drug retapamulin works better than other antibiotics that have been used for longer. More good quality trials are needed to answer this question. One thing is for sure: nowadays there are several antibiotic ointments that can effectively relieve impetigo symptoms.

Author: German Institute for Quality and Efficiency in Health Care (IQWiG)

References

  • European Medicines Agency (EMEA). Altargo. European Public Assessment Report. Scientific discussion. EMEA, 2007. Accessed on 24.03.2009: http://www​.emea.europa​.eu/humandocs/PDFs​/EPAR/altargo/H-757-en6.pdf.
  • Kuniyuki S, Nakano K, Maekawa N, Suzuki S. Topical antibiotic treatment of impetigo with tetracycline. J Dermatol. 2005; 32: 788-92. [PubMed: 16361729]
  • Koning S, Suijlekom-Smit LWA, van der Wouden JC. Impetigo. In: Williams H, Bigby M, Diepgen T, Herxheimer A, Naldi L, Rzany B (Eds.) Evidence-based Dermatology. London: Blackwell Publishing and BMJ Books. Second edition 2008: 354-357.
  • Koning S, van der Wouden JC, Chosidow O, Twynholm M et al. Efficacy and safety of retapamulin ointment as treatment of impetigo: randomized double-blind multicentre placebo-controlled trial. Br J Dermatol. 2008; 158: 1077-82. [PubMed: 18341664]
  • Koning S, Verhagen AP, van Suijlekom-Smit LWA, Morris A, Butler CC, van der Wouden JC. Interventions for impetigo. Cochrane Database of Systematic Reviews 2003, Issue 2. [Cochrane summary]
  • Nolting KS, Ulbricht HM. Antibacterial efficacy of an antimycotic: a double-blind study of ciclopiroxolamine versus gentamicin. Haut. 2003; 14: 115-117.
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