Impetigo is a common and contagious bacterial skin infection that causes anxiety when contracted during pregnancy. This superficial infection is recognizable by characteristic sores, but any infection during gestation raises questions about safety. Understanding the nature of impetigo and its safe management strategies can help expecting mothers feel informed and reassured. This overview addresses the specific concerns surrounding impetigo, its risk profile, and treatment while pregnant.
What is Impetigo?
Impetigo is a bacterial skin infection that affects the outermost layers of the epidermis, making it a superficial condition. It is most commonly caused by Staphylococcus aureus or sometimes by Group A Streptococcus (GABHS). The infection spreads easily through direct contact with the sores or contaminated objects like towels and clothing.
The infection usually presents in one of two forms: non-bullous or bullous impetigo. Non-bullous impetigo, the more frequent type, begins as small red sores that quickly rupture, leaving behind a distinctive, thick, honey-colored crust. The bullous form involves larger, fluid-filled blisters (bullae) that persist before bursting to leave a crust. In both cases, the infection is highly localized, remaining on the surface of the skin.
Assessing the Risk to Mother and Fetus
For the vast majority of cases, localized impetigo is considered low risk during pregnancy for both the mother and the developing fetus. Because the infection is superficial and confined to the skin’s surface, the bacteria rarely enter the bloodstream to cause a systemic infection that could affect the fetus. The main risk to the mother is localized discomfort, itchiness, and the potential for a secondary skin infection, such as cellulitis, if lesions are not treated promptly.
Systemic infection is not a characteristic of impetigo, meaning the bacteria do not cross the placental barrier to reach the fetus. There is a theoretical, extremely rare risk of post-streptococcal glomerulonephritis, a kidney complication associated with Group A Streptococcus infections. This complication is prevented by timely antibiotic treatment of the skin infection. It is important to distinguish common impetigo from Impetigo Herpetiformis, a separate, very rare skin disorder of pregnancy. Impetigo Herpetiformis is a severe inflammatory condition, not a bacterial infection, that carries risks to the mother and fetus.
Safe Treatment Options During Pregnancy
Medical management of impetigo during pregnancy focuses on eradicating the bacteria and preventing spread while selecting medications safe for gestation. For localized and mild cases, topical antibiotics are the preferred first-line treatment due to their minimal systemic absorption. Ointments containing Mupirocin or Retapamulin are commonly prescribed, applied directly to the affected areas for five to ten days. The crusts on the lesions should be gently removed with soap and water before applying the topical medication to ensure proper penetration.
When impetigo is widespread, involves deeper tissue, or causes systemic symptoms, oral antibiotics become necessary. Medications like Cephalexin, a cephalosporin antibiotic, are considered safe and effective for use during pregnancy. Other options, such as Clindamycin, may be used depending on the suspected bacteria and local resistance patterns. Certain antibiotics, such as Tetracyclines, are contraindicated during pregnancy due to their effects on fetal development. All antibiotic choices must be reviewed and prescribed by an obstetric provider to ensure the safety of the mother and the baby.
Hygiene Measures and When to Seek Urgent Care
Maintaining strict hygiene is the primary defense against the spread of impetigo, both to other areas of the body and to household contacts. Frequent hand washing with soap and water is necessary, especially after touching the infected area. Infected lesions should be kept covered with a clean, dry bandage or gauze to contain the infectious fluid and minimize transmission risk.
Towels, sheets, and clothing that have contacted the sores must be washed separately in hot water to sterilize them and prevent reinfection or spread. Scratching should be avoided, as this can worsen the infection, push the bacteria deeper into the skin, and spread the bacteria to uninfected areas.
Contact a healthcare provider if the prescribed treatment does not show improvement within 48 to 72 hours. Urgent care is warranted if the mother develops signs that the infection is progressing beyond the superficial skin layer. These signs include spreading redness, warmth, or significant swelling around the sores, red streaks leading away from the lesion, or systemic symptoms such as fever, chills, or generalized malaise. These symptoms may indicate a more serious condition, like cellulitis, which requires immediate medical attention.