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Crusty Crisis - Impetigo

Unveiled with crusty sores that are unsightly and highly contagious, impetigo can be more than a skin-deep nuisance in our classrooms. Affecting over 3 million children in the United States and 162 million children globally each year, this skin nemesis, colloquially known as "school sores" for its prevalence to spread quickly and easily through school settings, accounts for approximately 10% of skin complaints in the pediatric population and can significantly disrupt a student's learning experience, underscoring the essential conversation on effective preventive strategies, proactive healthcare policies, and supportive school management. 

Understanding Impetigo

Impetigo primarily results from two types of bacteria: Streptococcus pyogenes (strep) and Staphylococcus aureus (staph). Although the former usually results in non-bullous impetigo, also called "impetigo contagiosa" or "crusted," the latter is typically responsible for the bullous type (blisters), which is much rarer and generally affects children under the age of two. Non-bullous impetigo makes up 70% of all impetigo cases and is very common in kids aged two to five years old, although it can occur at any age.

Impetigo is usually a mild, superficial infection that can develop on any part of the body. Still, it commonly involves exposed skin, including the face, extremities, hands, and neck. Areas where there has been skin trauma, such as bug bites, scratches, abrasions, or even chafing caused by a runny nose, are especially susceptible. Poor hygiene habits, warm, humid climates, and crowded spaces (hello school!) all increase the risk of impetigo infections. 

Symptoms of Impetigo

Identifying impetigo involves recognizing symptoms initially appearing as small red spots, transforming into blisters filled with yellow or honey-colored fluid. Once the blisters burst, a scabby or crusty texture develops on the skin surface, which may spread to surrounding areas. The affected area may be itchy, sore, and irritating. Other symptoms may include swollen lymph nodes and fever, more typical in severe cases.

Unaddressed impetigo may result in potential complications like cellulitis, bacteremia, or scarring. Post-streptococcal glomerulonephritis, a serious kidney disorder, and rheumatic fever may also develop in rare cases. 

School Management of Impetigo

Managing impetigo in schools involves multiple facets, starting from early identification, notification of parents, implementing appropriate exclusion protocols, and reinforcing good hygiene practices.

Topical antibiotics are commonly prescribed when the skin condition is not severe or only a small area is affected. On the other hand, if the skin condition has spread over a large area, oral antibiotics are often recommended. Most guidelines suggest students stay home until they've undergone 24 hours of antibiotic treatment to minimize the spread. For student-athletes in contact sports, the AAP advises three days of antibiotic treatment before returning to their sport. During the healing process, cleaning the area with soap and water daily is important to remove any yellow scabs or crusts gently. Additionally, to avoid spreading the infection to others, covering the open sores loosely with a bandage is recommended.

Maintaining a clean environment, such as regularly cleaning common touchpoints (e.g., door handles), encouraging students not to share towels or other personal items, effective handwashing education, and proper wound care are also paramount in impetigo management.

Shared classrooms can become healthier learning havens with the right tactics to tackle this bacterial bane known as "school sores" because clear skin can equate to clearer minds.

Need a parent letter template re: Impetigo? Find one HERE.

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