Impetigo is a common, highly contagious bacterial skin infection that frequently causes concern during gestation. This superficial infection affects adults, including expectant mothers, whose immune systems are naturally altered to accommodate the developing fetus. Understanding the nature of this infection and the appropriate management strategies provides clarity regarding its implications for maternal and fetal health. This article examines the characteristics of impetigo, evaluates the potential risks during pregnancy, and outlines safe and effective treatment protocols.
Understanding Impetigo
Impetigo is a superficial bacterial infection of the epidermis, primarily caused by Staphylococcus aureus or, less commonly, Streptococcus pyogenes. These bacteria typically enter the body through minor breaks in the skin, such as insect bites, scrapes, or existing dermatological conditions like eczema.
The infection usually presents in one of two forms: non-bullous or bullous impetigo. Non-bullous impetigo, the more common type, begins as small blisters that quickly rupture, leaving behind characteristic honey-colored crusts. Bullous impetigo involves larger, fluid-filled blisters that remain intact for a longer period before breaking.
Assessing Fetal and Maternal Risks
For localized impetigo, the infection is generally considered a low-risk condition during pregnancy and poses minimal direct danger to the fetus. The infection remains confined to the superficial layers of the skin, meaning the bacteria do not typically enter the mother’s bloodstream in significant amounts to cross the placenta. Consequently, the development of the pregnancy is usually unaffected by a standard, localized skin infection.
The primary risks associated with impetigo are secondary complications for the mother if the infection is widespread or left untreated. These complications can include cellulitis, a deeper and more serious skin infection requiring systemic treatment. A rare complication following Streptococcus pyogenes infection is post-streptococcal glomerulonephritis, a kidney condition that can develop weeks after the initial skin infection.
It is important to differentiate typical impetigo from Impetigo Herpetiformis, a very rare, non-bacterial skin condition. This severe form of pustular psoriasis occurs in pregnancy and is associated with systemic symptoms. It carries risks for both the mother and the fetus, including placental insufficiency and electrolyte imbalances, and must be managed separately from common bacterial impetigo.
Safe Treatment During Pregnancy
The management of impetigo in pregnant individuals prioritizes the safety of both the mother and the developing fetus while effectively clearing the infection. For localized, non-bullous impetigo, topical antibiotics are the first line of treatment. Mupirocin ointment is the preferred agent, as it works directly at the site of infection and has minimal systemic absorption, making it safe for use throughout pregnancy.
Prior to applying the topical medication, the crusted lesions should be gently cleaned with soap and water to remove the crusts, allowing the antibiotic to reach the bacteria. If the impetigo is bullous, involves a widespread area, or does not respond to topical therapy, systemic oral antibiotics become necessary. The choice of oral antibiotic is carefully guided by its safety profile during gestation.
First-generation cephalosporins, such as cephalexin, and penicillin derivatives like dicloxacillin, are generally considered safe and effective first-line systemic options for pregnant patients. These medications effectively target the common causative bacteria. In cases where methicillin-resistant Staphylococcus aureus (MRSA) is suspected or confirmed, clindamycin is often the preferred first-line choice due to its safety profile during pregnancy.
Certain antibiotics are either avoided or used with caution. Tetracyclines can affect fetal bone and tooth development, and sulfonamides are contraindicated near term. Erythromycin’s estolate form should be avoided due to potential maternal liver toxicity. Therefore, any systemic treatment requires careful selection by a healthcare provider to ensure the best outcome for the mother and child.
Preventing Contagion and Recurrence
Because impetigo is highly contagious, strict hygiene practices are necessary to prevent its spread to other body areas or household members. Frequent and thorough hand washing is essential, especially after touching or treating the lesions. The infected sores should be kept clean and covered loosely with a bandage or gauze to contain the infectious fluid and prevent transmission.
To avoid spreading the bacteria through objects, personal items like towels, washcloths, and bed linens should not be shared and must be washed at a high temperature. Surfaces frequently touched, such as doorknobs and counters, should also be disinfected regularly.
Preventing recurrence involves addressing any underlying skin issues, such as promptly treating cuts, scrapes, or conditions like eczema that compromise the skin barrier. If the infection recurs frequently, a healthcare provider may test for nasal carriage of S. aureus and treat it with a specific nasal antibiotic ointment.