Treatment of impetigo

Editor—Koning and van der Wouden in their editorial on treatment of impetigo discuss the relative merits of systemic and topical antibiotics that were reported in their recent Cochrane review and add that they have no evidence to support the therapeutic value of disinfecting agents, which they note have hardly been studied.¹ They comment that studies establishing the value of disinfecting agents are therefore most welcome.

Generations of general practitioners have treated impetigo with gentian violet, and although there has been some trial evidence that its effectiveness extends to methicillin resistant Staphylococcus aureus,² the main support for its use is clinical experience passed on from one practitioner to the next and reinforced by the rapid resolution they see when failures with more cosmetically acceptable topical antibiotic preparations lead to a trial of gentian violet.

The processes developing evidence based practice must be able to promote those treatments that have been reliably proved while somehow preventing the loss of longstanding effective remedies for which there will never be a commercial imperative to fund trials. Surveys that aggregate the collective experience of practitioners and identify treatments that are perceived as effective but have not been evaluated should trigger investigation, perhaps through the health technology assessment route, rather than lead to abandoning the treatment and sending another baby down the plug hole with the bath water.

For those who might be stimulated by this letter to try gentian violet for impetigo, the agent must be kept away from the cornea.³