What is impetigo?

Impetigo is a common, highly infectious skin disease caused by staphylococcus bacteria or more rarely by the streptococcus bacteria. It isn't dangerous but it is an extremely contagious illness.

There are two types of impetigo: bullous and non-bullous.

Bullous impetigo causes fluid-filled spots that don't burst easily and tend to last for a few days. They are usually found on the chest, back and abdomen (tummy) and in folds of skin, such as on the neck or underarm, or on the nappy area in babies.

Non-bullous impetigo is more common and starts with small fluid-filled spots that quickly burst and leave yellow-brown crusts. They usually occur on the face around the nose or mouth, or on the arms or legs.

If impetigo develops in healthy skin it's called primary impetigo. Sometimes impetigo starts in an area of broken skin, for example, at the site of a wound, or an area affected by another condition that breaks the skin, such as eczema, scabies or head lice. This is called secondary impetigo.

What does impetigo look like?

It first appears as a small scratch or itchy patch of eczema - skin inflammation - on seemingly healthy skin. A small red, itchy spot quickly develops into a blister containing a yellow substance.

Later, the top of the blister becomes crusty and weeps while new blisters develop in the same place or on other parts of the body. Impetigo usually begins on the face, especially around the corners of the mouth, the nose and back of the ears.

Who is at risk of infection?

Children and adolescents suffering from eczema (atopic dermatitis) are especially likely to develop impetigo. Thorough skincare is important to prevent infection. Impetigo is easily spread through contact, so it is commonly seen in nursery or playgroup settings.

How is impetigo treated?

If you suspect impetigo, contact your doctor as treatment should take place preferably before the child infects other children. The treatment involves washing with soap and water and letting the impetigo dry in the air. Many doctors choose to treat impetigo with bactericidal ointment, such as fusidic acid or mupirocin; but in more severe cases oral antibiotics, such as flucloxacillin or erythromycin are necessary. It is important to dissolve the scabs with ointment because the bacteria that cause the disease live underneath them.

When can my child begin to mix again with other children?

A preschool child should not return to nursery school or playgroup until the scabs have fallen off and they are no longer contagious. Small children will touch and scratch their scabs and therefore run the risk of infection. Schoolchildren can normally return to their classes after one week from the start of treatment even with scabs as long as they remember not to scratch or touch them. Above all, they must remember to wash their hands regularly and only use their own comb, brush, facecloth or towel. It is important that the school fully understands the nature of impetigo, and that the presence of scabs does not necessarily mean that a person remains infectious.

Are there any complications from impetigo?

Complications of impetigo are uncommon and are more likely to occur if you have bullous impetigo. If impetigo spreads to other areas of your body, it is possible (but uncommon) to develop;

A skin infection (cellulitis) – the impetigo can spread into the lower layers of your skin and cause pain, redness and swelling.

Blood poisoning (septicaemia) – rarely, impetigo spreads beyond your skin into your bloodstream and can cause a serious infection that needs emergency medical attention.

Kidney infection (glomerulonephritis) – rarely, your immune response to the impetigo infection can cause kidney problems.

Scarlet fever – the bacteria that cause impetigo can cause sore throat, fever and reddened skin.

Guttate psoriasis – a type of psoriasis that looks like dry scaly patches on your skin, and can occur after bacterial infections, but usually gets better on its own.

General advice for dealing managing impetigo

  • Cut your child’s nails short and encourage them not to scratch their scabs, pick their nose, bite their nails or suck their fingers
  • If your child already has eczema seek advice and effective treatment
  • Always remember to wash your hands after having touched your own or your child’s scabs
  • Teach your child to wash their hands regularly and always give them their own facecloth and towel
  • Explain to your child why they need to pay special attention to hygiene and avoid touching their scabs