Recognising and treating bark/growth lichen

Impetigo contagiosa, or bark lichen, is not uncommon in children. In this clinical picture, red patches of skin appear relatively suddenly, usually on the arms, face or at the entrance to the nose. These become larger and larger, and blisters can also develop. In most cases, the skin bursts, then oozes a little and usually forms a honey-yellow scab. The whole thing usually spreads quickly.

The cause is bacteria - streptococci or staphylococci.

For us paediatricians, a visual diagnosis is actually sufficient. It's easy to recognise whether it's a case of lichen. Theoretically, a swab can also be taken, but this is usually not necessary.

If the disease is recognised early, you can try to treat it locally with disinfectant sprays or local antibiotic creams. However, it is often the case that internal antibiotics are also necessary to dry out the inflamed areas of skin all over the body.

The question often arises as to when children can go back to nursery school. This is because, very importantly, the skin areas are very contagious. If children scratch there, they have the pathogens on their fingers, which they can then pass on to others. The pathogens can also be transmitted via toys or door handles. The rule is that if the children are treated systemically, i.e. with juice and tablets, with an antibiotic, they can return to nursery school after 48 hours. If untreated, they can only return when all the spots have healed properly.