Eczema (picture 9) may predispose the skin to impetigo.
The infection usually spreads by autoinoculation.
Recurrences are often caused by bacteria remaining in the nostrils from where they are re-spread by fingering of the nose.
Treatment
Treatment is started on the basis of the clinical presentation.
If the disease is confined to a small area the treatment consists of soaking the crusts so that they are detached, and applying an antimicrobial ointment (fusidic acidInterventions for Impetigo or a combination of neomycin and bacitracin).
The most common reasons for poor response to treatment
The diagnosis is incorrect. The patient has scabies, lice, or ringworm.
The crusts have not been soaked and removed. The bacteria can survive under crusts.
The underlying eczema has not been treated.
The nostrils serve as reservoir for bacteria (apply neomycin-bacitracin or fusidic acid ointment into the nostrils. Mupirocin should not be used for this disease as its use should be limited to the eradication of methicillin-resistant Staphylococcus aureus).