What are the clinical features?
There are two clinical types of school sores.
The Crusted type (non-bullous impetigo) accounts for 70% of cases. They start out as blisters or pustules that rupture. The crust is usually yellow, orange or brown in colour and can become quite thick as it accumulates.
The bullous type (bullous impetigo) accounts for 30% of cases. The lesions are eroded and red. They actually start as “bullae” which are large blisters but they burst almost as soon as they form. Look for the the edge of the blister just inside the rim of the lesion. The surface may be red, moist or covered in a thin honey-coloured crust. Classical bullous impetigo represents toxin produced by the Staph bacteria.
Gallery of School Sores
Please click on the images for details.
How long does my child need to stay away from school or daycare?
Even though impetigo is not usually a serious infection, children who have it are very infectious (contagious). Fortunately, your child can lessen the severity of this illness if he or she practices good hygiene, wears an appropriate dressing/covering at all times and does not interact with other children until they are no longer infectious.
States each have their own timeout rules for health conditions. The Queensland government timeout guideline states, “Exclude until person has received appropriate antibiotics for at least 24 hours. Cover weeping or crusted sores on exposed areas with a watertight dressing until at least 24 hours after commencing antibiotics and for as long as practical. Sores are not contagious if covered, or after the child has taken antibiotics for 24 hours.”
It is common for a GP to see a whole family who have passed school sores to each other.
Six School Sore Snippets:
- School sores are most common on the face and forearms/lower legs; however, they can be present anywhere on the body.
- School sores are very common in school-aged kids – but also occur in adults (impetigo).
- The condition is highly contagious, and young children pass it to each other very readily.
- Start treatment early for ease of treatment and to get back to daycare/school/work as soon as possible.
- Children with eczema or other skin conditions are more likely to get a severe infection.
- Recurrences can be caused by self-infection from staph carried in places like the nostril.
Symptoms may fade on their own in very mild cases. However, this risks the condition spreading and infecting other people. Antibacterials are the best treatment of choice.
Mild cases of impetigo can be treated with prescription antibiotic cream or ointment. The usual treatment in Australia is Mupirocin (®Bactroban), which is applied three times per day for ten days.
More widespread infections will need oral antibiotics such as Flucloxacillin or Dicloxacillin, or Cefalexin for 5-10 days.
Completing a prescribed course of antibiotics is extremely important. Leaving impetigo untreated can lead to skin abscesses in some cases.
It’s probably fair to say that kids are often treated with oral antibiotics for mild school sores when topicals might do the job just as well.
Clearly, it’s very disruptive to a family for a child to be out of daycare for any longer than is necessary – for example, in a child who doesn’t respond to topical antibiotic and subsequently needs oral antibiotics. On the other hand, antibiotic resistance is now “an urgent global health priority.” Overall, the guidelines are very clear that topical antibiotics are preferred to oral antibiotics for mild cases¹.
How do I treat recurrences?
Recurrences are common in children and may be caused by infection off playmates or auto-infection (infecting themselves).
Your doctor may suggest a swab just inside the nose for staph that may be harbouring there. It may also be worth getting a swab of an infected lesion to check for unusual bacteria. In addition, resistant staph such as MRSA can cause impetigo.
There are various methods to try to reduce staph carriage on the skin. These methods also apply to kids who get recurrently infected with eczema.
- Antibacterial soaps – some come as bars, some as dispensers.
- Antibacterial Bath products. Manufacturers such as QV, Cetaphil and Dermeze produce these.
- ®Condys Crystals in the bath.
- Chlorhexidine in the bath.
- Sodium hypochlorite baths.
There isn’t hard evidence to say which of these methods is best or if they even work. However, it is usual to recommend an antiseptic bath for children with recurrent impetigo because it just might stop another disruptive round of School Sores.
You can find more information from health direct australia.