Impetigo

You might have never heard about this word, maybe you've heard it multiple times, or even heard it said differently such as Infantigo. But what is this skin infection called Impetigo?

 

What is Impetigo?

Impetigo is a very common skin infection seen mainly in children that is usually caused by a bacteria called Staphylococcus Aureus (AKA Staph). It may occur anywhere on the skin, but usually in areas that have received some cut, trauma, bite, or abrasion. The face near the nose is a very common area to see these lesions. Sometimes it can occur after a runny nose causing irritation of the skin, leading to Impetigo.

 

What does it look like? 

It can start as very tiny sores, pustules, or small blisters, and as they rupture they develop a honey-colored crust on top, very characteristic. Impetigo does have a less common variant, called bullous Impetigo. This type has large bullae, like blisters, on the trunk, but can occur anywhere too. 

 

Can it spread? 

It usually starts as one lesion that spreads very easily due to scratching. It may spread from under the nails to other areas nearby or elsewhere on the body. To prevent this spread it is important to keep the nails short and clean, also to avoid scratching and touching the lesions.

 

It can also spread to other children by directly touching them or surfaces they might touch. It is very common in certain sports due to the direct contact, such as wrestling or football.  It is highly contagious!

 

Can it be treated? 

Yes! It is treated with antibiotics. The first line of treatment, unless severe and already expanded, is a topical antibiotic cream or ointment such as Mupirocin 2%. This is used 2-3 times a day on the affected lesions for 7 days. It tends to improve within 48hrs. 

 

In certain cases, where the lesions have already spread, they are resistant to the topical treatment, or it has been diagnosed or treated late, it is recommended to take oral antibiotics, such as Cephalexin. 

 

Can it be resistant to standard antibiotics?

In certain cases, it can be MRSA impetigo. This means it is caused by a Staph strain that is resistant to standard antibiotics and needs to be treated with stronger antibiotics such as Clindamycin. 

 

Is it dangerous?

Most Impetigo is pretty benign; it heals without scarring. But it can sometimes cause complications, such as:

• Cellulitis: infection that affects the tissue under the skin and can spread to the bloodstream. This can become life threatening if left untreated.
• Glomerulonephritis (kidney problem): Impetigo can cause a reaction in the kidneys that can lead to kidney damage.

What should I do once my child has it?

1. Call your pediatrician or telehealth service for antibiotic treatment.
2. Keep nails short and clean.
3. Wash linens, clothes and towels with hot water.
4. Avoid sharing towels and clothes.
5. Keep lesions covered when in contact with other children.
6. Try to keep lesions loosely covered, the scabs need airflow to heal. 
7. If attending school, sports or daycare, always cover lesions. 
8. If not improved after 2-3 days of starting the ointment (or oral antibiotic if needed), seek medical care again.

When can your child go back to school, daycare?
24 hours after starting the antibiotic (topically or orally) kids may return to daycare, school, or sports.

 

Can they get it again?

Unfortunately, yes. Many children have this infection recurrently. They might even be colonized by the bacteria, usually in their nose, even though they may not have symptoms in their nose. This colonization can lead to a child getting Impetigo after any minor skin lesion such as insect bites. If the infection is recurrent, your pediatrician may want to swab your child’s nose to check for the staph bacteria.

 

If you have any questions about Impetigo, please log into your account and send us your question. We are here to help.

 

Dr. Valerie Hines, MD FAAP

Healthy Communication, Part 2: Team Members

Sarah Miller had been a high school history teacher for nine years. She'd always liked the school administration and her colleagues.

 

But in mid-March 2020, the pandemic hit, and Sarah, like all teachers at her school, was sent home to teach classes remotely. 

 

Little by little, the COVID-19 crisis began to take its toll. Sarah was feeling increasingly stressed.  

 

Unexpected demands had become part of her everyday life. Having to learn new technology platforms to improve the quality of virtual teaching left her feeling overwhelmed and defeated.

 

Sarah felt as if every time she began to settle into the "new normal" of her job, the government passed new laws in response to the pandemic. District leaders imposed changes in school directives, and Sarah was back at square one.

 

A few weeks into the process, Sarah uttered something she never thought she'd hear herself say: "I hate my job." She couldn't put her finger on what was wrong. Sarah was unaware of the fact that she was mourning the loss of some people and things that had previously given her a sense of stability and well-being:

 

The personal connection with other teachers, in particular, her two closest friends who taught alongside her in the history department. 

 

The experience of interacting face-to-face with kids. As a teacher, Sarah's "edge" was inserting her fun and energetic personality into the classroom. For the previous two years, students had voted her their favorite teacher.

 

The security of using a proven teaching and classroom management plan she had created and fine-tuned over the course of her teaching career.

 

In addition to the stress that resulted from these losses, fear had crept into Sarah's thinking. Worrying that she wouldn't be able to keep up with the ever-changing requirements of virtual teaching created an underlying feeling of panic. How would she stay connected to her colleagues and keep students engaged with history?

 

Like Sarah, we all know what it means to be stressed. The term "stress" can refer to a wide variety of phenomena: 

• We experience stress when pressures or demands make our lives difficult or interfere with our ability to maintain a feeling of well-being. 
• Sometimes people describe "feeling stressed" as an emotional state, one that involves anxiety and exhaustion. This is often referred to as "burnout".
• A situation that overwhelms a person's perceived ability to meet the demands of that situation is experienced as stress.

One strategy for addressing stress in our lives is to communicate in a healthy manner. This begins with the way we approach circumstances and the messages we tell ourselves. For example:

• Taking small positive actions on a daily basis is more effective than attempting to make radical changes overnight.
• Blaming discomfort on outside events keeps us from facing the real issue - our attitudes. We have choices. We can either see ourselves as victims, or we can accept what is happening and take responsibility for our response.
• Focusing our energies on what we can control and letting go of what we cannot control reduces the frustration and resentment that result from unrealistic expectations.
• Condemning ourselves for our imperfections robs us of the opportunity to see and celebrate progress. 
• Asking for help is a sign of strength, not weakness.
• Searching for "the" answer prevents me from identifying and exploring viable options.

Equally important as what we tell ourselves is how team members treat and talk to one another. We each have the power to reduce stress through building connectedness and community. This becomes possible when we: 

• Invite others to be part of what we are working on. 
• Initiate conversations about the goals we have for ourselves and what we're doing to reach them.
• Agree on a clear and commonly accepted team purpose.
• Discover obstacles that can be removed in order to achieve personal and collective goals.

After recognizing that fear and discomfort had been contributing to her stress and frustration, Sarah realized she had the power to make choices that would improve her sense of well-being. Over time, she began taking specific steps toward adapting the way she communicated with herself and colleagues in light of the challenges of COVID-19. 

 

Sarah's stress and frustration with her job began to turn around when she asked: "Am I willing to change? What do I have the power to change? Which actions will have the greatest impact on achieving these changes?"

 

If you have any questions about healthy communication, please log into your account and send us your question. We are here to help.

 

Dave Tarpley, MEd

Consultant and Executive Coach 

 

For more on Dave click here.

Healthy Communication, Part 1: Leaders

As a young boy growing up in a coastal Florida city, the threat of hurricanes was frequent and distressing.

 

Several Category 4 hurricanes slammed their way through our neighborhood. I distinctly recall watching three towering pine trees in our front yard crash to the ground within minutes of each other, one of which smashed into our house.  If we still had power, my dad would tune the television to the local weather station to track the hurricane's path. The weatherman was our leader, the one we were counting on to steer us to safety.

 

During this “hurricane” called Covid-19, progressive leaders understand that creating and managing a crisis-communications program requires the same commitment they give to other parts of the organization. Above all, they put their people first. When leaders prioritize employees' safety and morale, not just business needs, people feel protected and supported.

 

What kinds of strategies might be part of a crisis-communications program? 

• In uncertain times, effective leaders consistently communicate to their people how they uniquely contribute to the organization's goals and values. This gives them a sense of motivation, fulfillment, purpose, and belonging, inspiring them to act because they want to, not because they have to.
• Not surprisingly, healthy communication is characterized by a high level of trust. When people feel safe they can ask for help, admit mistakes, and take responsibility. These acts of vulnerability feel risky. A leader who models vulnerability gives others the courage to take off their masks and be real. 
•  Healthy companies are a place where people are recognized for their intrinsic value, rather than as a cost unit, function, or sum total of their achievements. Leaders spend less time trying to exert control and more time building cooperation with their team members. 
•  A problem some people experience in times of uncertainty is fear of the unknown. A way to combat that fear is to establish a few “certainties” in the form of structure and routines. Regularly-scheduled Zoom meetings or on-site group meetings that allow for employee input, time for questions and answers, and even laughter, help people live in the present and feel connected. This reduces anxiety and increases focus.
•  It is also helpful to provide your team with tangible action items. Having specific next steps gives people a sense of control and the reassurance that they are making a contribution toward stabilization. Use words like, “Here are the next steps we are taking” or “Here's what you can do” to demonstrate action. 
•  By not withholding information, leaders can build trust with their team and create a bond. As a leader, it is essential to be honest about successes and failures, goals, and financial activities. Changes that could negatively impact the team should be shared truthfully. Promoting transparency will allow your team members to feel comfortable voicing their concerns to you and their colleagues while reducing possible conflict areas and building trust. 

Natural disasters like hurricanes and earthquakes invariably leave behind them a path of destruction. But as they “rise from the ashes”, homeowners and business leaders have the opportunity to rebuild, but differently. They call in architects who can design structures that are safer and more solid, better able to withstand inevitable future calamity.

 

Ultimately, the benefit of having a crisis-communication program is that it clarifies the kind of organization you want to have. Will your organization focus on goals at the expense of valuing the needs of your people? Or will you recognize that your people are your most treasured resource in the quest to reach those goals? The answers to these questions form the way you communicate with your employees, and allow you to seamlessly transition from crisis mode to a new normal.

 

I am not a quantitative researcher. My conclusions about people and organizations aren’t rooted in statistics or data. I am a consultant and executive coach who asks questions that guide people in exploring what they are willing to do differently in order to get different results.

 

What is possible if you become willing to do something different? What do you risk if you don’t?

 

If you have any questions about healthy communication, please log into your account and send us your question. We are here to help. 

 

Dave Tarpley, MEd Consultant and Executive Coach

 

For more on Dave click here.

 

Your Diet During Pregnancy

Once you find out that you are pregnant, you may have questions.  One of them might be what to eat and what not to eat during this time.  Pregnant or not, eating a variety of foods is a good way to ensure getting what you need for health.  Pregnancy is a great time to focus on getting the best nutrition possible. 

 

What should you eat during pregnancy?

 

Fruits and vegetables provide nutrients not found in other foods.  So that's a good place to start.  Eat them!  Your doctor will likely prescribe prenatal vitamins.  But, while you should take them, they do not replace a nutritious diet.  If you aren't eating at least 2-4 servings per day of fruit and 4 or more servings per day of veggies, you should work on increasing your dietary intake.  This would provide vitamins, minerals, and fiber, as well as other phytonutrients.  These are natural chemicals that help protect plants from germs, fungi, bugs and other threats.  It is thought that they may help prevent disease and keep your body functioning properly, though they are not considered essential.  There are more than 25,000 phytonutrients found in plant foods, including antioxidants.  

 

Other sources of phytonutrients are whole grains, nuts, and beans.  While you may hear of diets that recommend avoiding or limiting carbohydrates, these foods (including beans and whole grains) are the body's main source of energy.  They also provide iron, B vitamins, fiber and some protein.  Aim for 6 - 11 servings per day of foods from this important food group.  How many servings you should have is based on your weight and individual needs.  Consult a Registered Dietitian (RD) for an individualized plan.  If your doctor's office does not have an RD on staff, they may be able to refer you to one.  Your health plan may cover this.

 

Your developing baby needs plenty of protein, things like meat, poultry, fish, eggs, and beans.   These foods also provide B vitamins and iron.  Iron helps carry oxygen to your baby but also to your muscles, which helps prevent fatigue, weakness, depression and irritability.  Three servings a day - 3 ounces equals a serving - provides about 27 grams of protein, the U. S. RDA or Recommended Dietary Allowance.  

 

Another nutrient to pay attention to is calcium.  You will need at least 1,000 milligrams of calcium daily to help build strong bones and teeth.  If your diet doesn't provide this, your body draws it from your bones.  Four servings a day of milk, cheese, or yogurt will supply this.  Calcium is also contained in green leafy vegetables, seafood, beans, and dried peas.  If you prefer a nondairy "milk," check to see how much calcium it contains.  Your body can't utilize a lot of calcium intake at one time, so try to eat the four servings separately throughout the day.  Calcium from food is also better for your body than taking a calcium supplement.

 

If you are not used to eating some of these healthy foods, try searching for different ways to prepare them.  There are many resources available for recipes.  This is another service an RD can offer.   

 

What foods or drinks should you avoid during pregnancy?

 

Here are some foods to limit or avoid...

• A 12-ounce cup of coffee has about 200 milligrams of caffeine.  That is generally considered safe during pregnancy.  Try to limit yourself to that one 12 ounce cup.
• Alcohol, however, is best avoided at this time as it passes directly to your baby and is associated with fetal alcohol spectrum disorders.  
• Also avoid fish containing high levels of mercury.  Swordfish, shark, king mackerel, marlin, orange roughy, and tilefish fall into this category.  Some tuna also contains mercury.  The safer choice is the canned light tuna, though canned white tuna, also called albacore, is considered safe to have (6 ounce portion) three times a month.  
• Stay away from unpasteurized food, including juice, milk and cheese, when you are pregnant.
• Also avoid raw or rare/undercooked meat and poultry, raw or undercooked fish or shellfish.  
• Don't eat raw or undercooked eggs or foods that contain them.
• Avoid raw or undercooked sprouts.  

If you have any questions about diet during pregnancy, please log into your account and send us your question. We are here to help.

Sydney Rephan, RD, LD

Contact Dermatitis: Part 2

Last week we talked about the symptoms and causes of contact dermatitis.  Today I want to talk about how contact dermatitis is diagnosed, how it can be prevented, and how to treat it.
 

How do we diagnose contact dermatitis?
 

Much of the diagnosis is made based on the appearance of the rash along with a good history to uncover clues about the possible causes. 
  

If your doctor suspects an allergic cause, they might recommend allergy testing, such as a patch test, to confirm the diagnosis.  
 

How is a patch test done?
 

Small amounts of the possible trigger allergens are put on patches that adhere to your skin like tape.  You will then go home with these patches in place, where they will stay on for 2-3 days.  You will need to keep your back dry during that time period.  After 2-3 days, you return to the doctor to have the areas evaluated for skin reactions.  
 

What can be done to prevent contact dermatitis?
 

There are several things that you can do for prevention.  Here are a few:

• Avoid triggers - For instance, make sure you know how to identify poison ivy and avoid it.  Avoid overuse of hand sanitizer or other irritants.  
• Wear protective clothing - Depending on the possible exposure, you can wear gloves, long sleeves, face mask, or goggles to protect you against irritating substances.
• Wash your skin after exposure - If you do come in contact with an allergen or irritant, wash your skin right away after coming in contact with it.  Use warm water and a mild soap.  Rinse completely.  Also put any clothes that you were wearing into the washing machine before washing your skin, so that you don't get exposed again from touching those clothes.
• Use a barrier cream - This protective layer may prevent the irritant or allergen from penetrating your skin.  For example, an OTC cream such as IvyBlock may prevent or lessen a skin reaction to poison ivy IF you apply it before you come into contact with the plant.
• Keep your skin healthy - Use moisturizers regularly, and treat cuts and scrapes appropriately, which can help keep your skin healthy enough to keep some reactions to a minimum.
• Be careful of pets - Pets can carry some allergens or irritants on their fur after they are exposed (including poison ivy).  They can then spread these substances to people.  
• If you are sensitive to nickel, look for nickel-free jewelry.  You can also apply an iron-on patch to the inside of clothing that contains metal buttons to keep them from contacting your skin. 

How is contact dermatitis treated?

• Eliminate any exposure to triggers - If you develop an irritant reaction to hand sanitizer, you should stop using it.  If you develop an irritant or allergic reaction to cleaning chemicals, you should stop using them or always wear gloves when you need to use them.  This is an important step in treatment.
• Steroid creams or ointments - You might initially try some OTC steroid treatments, such as hydrocortisone 1% cream or ointment (I think the ointment works a little better.)  If this does not help, your doctor might prescribe a stronger steroid cream or ointment.
• Antihistamines - You might initially try OTC antihistamines, such as Benadryl.  If OTC antihistamines don't help, your doctor might prescribe a different oral antihistamine.
• Oral steroids - In severe cases, your doctor might prescribe an oral steroid such as prednisone, which can reduce inflammation in the skin, and decrease your allergic reaction.
• Antibiotics - Antibiotics are not indicated as treatment for contact dermatitis.  However, if you have severe contact dermatitis, and scratch excessively, you can develop a secondary skin infection.  In that case, your doctor may prescribe either topical or oral antibiotics.  
• Wet compresses - Use cool, wet compresses (a towel or wash cloth wet with cool water) on the affected area for 15-20 minutes at a time, several times a day.
• Avoid scratching - If you can't keep yourself from scratching, apply a dressing over the area to avoid direct contact.
• Soak in an oatmeal bath, or take a cool shower.

If you have any questions about contact dermatitis treatment or prevention, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Contact Dermatitis

Contact dermatitis is a rash caused by direct contact with a substance that either irritates the skin or causes an allergic reaction within the skin.  Although the rash is not life-threatening, it can be very uncomfortable.  
 

Many different substances can cause contact dermatitis as we will talk about below.  Recently, many people have developed contact dermatitis as a result of frequent use of hand sanitizer.  I thought this would be a timely topic for our discussion this week.
 

What are the signs and symptoms of contact dermatitis?
 

Symptoms usually occur in areas that have been directly exposed to the irritant or allergen.  For instance, with poison ivy, it would be the area that came into contact with the plant or oil from the plant.  Hand sanitizer would most commonly cause symptoms on the hands.  
 

Here are the things to look for: 

• A red rash, which may include bumps and blisters
• Blisters may develop oozing and crusting
• Itching, which can be quite severe
• Cracked and scaly dry skin
• Swelling   
• Burning sensation
• Tenderness

What causes contact dermatitis?
 

Contact dermatitis can be caused by two different types of substances.
 

The first type is irritants.  Irritants are substances which damage your skin's outer protective layer.  Sometimes people react to a strong substance after one exposure.  Other times, the reaction develops after repeated exposure to milder irritants.  

Here are some common irritants:

• Products containing rubbing alcohol, including hand sanitizer
• Solvents
• Bleach and detergents
• Hair products, including shampoos, hair dyes, or perm solutions
• Fertilizers or pesticides
• Sawdust
• Wool, or wool dust

The second type of substance is something that causes an allergic reaction within the skin.  Something that causes an allergic reaction is called an allergen.  This allergic skin reaction usually only affects the skin that was directly exposed to the allergen.  But it can be triggered by something that you eat or drink, such as foods, food dyes or flavorings, or medication.  It is also possible for something that contacts the skin in one area to cause an allergic reaction in the skin all over the body.  Sometimes you may react to an allergen the first time you are exposed, but you can also develop an allergy after multiple exposures over several years.  
 

Here are some common allergens:

• Nickel, found in jewelry, belt buckles, and many other items
• Plants, such as poison ivy
• Medications
• Formaldehyde, found in disinfectant, preservatives, and some clothing
• Balsam of Peru, used in many products from perfumes to mouth rinses
• Personal care products, such as deodorants, cosmetics, nail polish, etc.
• Products that cause a reaction when your skin is exposed to sunlight, such as some medications and some sunscreens.

Are some people at higher risk for contact dermatitis?
 

People who have certain hobbies or jobs are at higher risk simply because they are exposed to more of the possible causes.  These include:

• Health care workers
• Metal workers
• Construction workers
• Hairdressers and cosmetologists
• Auto mechanics
• Cleaners
• Gardeners, farmers, and agricultural workers
• Cooks and others who work with food

 Are there complications that might occur from contact dermatitis?
 

The primary complication is infection in the skin, which is not uncommon if you repeatedly scratch the affected area.  Scratching damages the skin and allows bacteria or fungi to grow.
 

Next week, we will talk more about prevention and treatment of contact dermatitis.  

If you have any questions about contact dermatitis, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor