Patient information from BMJ

Impetigo

Last published:Oct 25, 2024

Impetigo is a common skin infection that is easily spread from person to person. It usually occurs in children who catch it in school or playgroup.

It can be treated with a short course of antibiotic cream or ointment. But, in some cases, stronger antibiotics may be needed.

What is impetigo?

Impetigo is a skin infection, usually caused by bacteria called Staphylococcus aureus (S aureus) or Streptococcus pyogenes (S pyogenes). In Europe, S aureus is the most common cause. You might also hear this called 'golden staph'.

Impetigo spreads easily from person to person, usually through direct contact. You’re more likely to catch it if you have broken skin - for example, from a graze, an insect bite, or eczema. Impetigo is more common in children than in adults, but it can affect people of any age. It’s also more likely if you have:

• poor hygiene

• overcrowding

• malnutrition (a serious condition that can happen if your body doesn’t get the right nutrition)

• a weakened immune system (for example, because of diabetes, cancer, or HIV).

There are two types of impetigo. The most common is called crusted or non-bullous impetigo. It starts as small blisters, which quickly burst and crust over in golden-brown patches. The other type, called bullous impetigo, causes large blisters that ooze yellow liquid before scabbing.

What are the symptoms?

The main sign of impetigo is the golden-brown crust that forms when the blisters burst. Some people say it looks like cornflakes stuck to the skin. The skin around blisters may also have redness, though this can sometimes be harder to see on black or brown skin.

Impetigo tends to be found on the face (often around the nose and mouth), but it can happen on any part of the body.

Most people won’t have any symptoms, but impetigo can sometimes be itchy. Pain is very uncommon. In some cases, people with severe infection may experience fever and swollen glands too.

Doctors can usually diagnose impetigo just by looking at your skin. A skin swab might be needed if your doctor thinks the infection is caused by a type of bacteria that’s resistant to antibiotics. These swabs will then be sent to a laboratory for testing.

What are the treatment options for impetigo?

Most cases of impetigo will go away on their own without any treatment. But most people are advised to have treatment, because it spreads so easily.

Simple infections can be treated with an antibiotic cream or ointment. Your doctor will tell you how to use this treatment when they prescribe it.

Along with antibiotics, your doctor will also recommend you practice good skin hygiene. This helps to reduce the amount of bacteria on your skin. You should wash twice daily with soap and water or an antibacterial cleanser.

If antibiotic creams or ointments haven’t worked, or if you have a more severe infection, your doctor may prescribe antibiotic tablets instead. These will usually need to be taken for around 7 days.

If antibiotic tablets aren’t helping your impetigo, your doctor may do a skin swab to find out what type of bacteria is causing the infection. This is because some antibiotics work better for certain infections.

In severe cases of impetigo, the infection can spread deep in your skin or to your blood. The chance of this is very low for most people. Serious infection is more common in people with weakened immune systems or in newborns with bullous impetigo. If a serious infection does happen, you will be treated in hospital with antibiotics given through a drip (called an intravenous infusion or IV).

What happens next?

Most cases of infection are simple and can be treated with antibiotic creams or ointments, but impetigo can come back.

If your impetigo comes back regularly, you might be given a nasal antibiotic in addition to other treatments. This is because the bacteria that cause impetigo can live in the nose as well as on the skin. So nasal antibiotics can help reduce the chance of future infection. Your doctor will speak to you about this if they recommend this.

The chance of severe infection with impetigo is very low. But if this does happen, you will need to go into hospital to receive treatment.

Stopping the infection from spreading

Because impetigo spreads so easily, it’s important to try to avoid passing it on to other people. You can do this by:

• Practising good skin hygiene. You should wash twice-daily with soap and water, or with an antibacterial cleanser.

• Avoid scratching your skin if you can. You should also keep your nails short as this will reduce the chance of infection spreading if you do scratch your skin.

• Keep contact with other people to a minimum. This means staying away from work, school, or nursery until the risk of spreading infection is low. This is usually until the blisters are crusted or healed, or 48 hours after starting antibiotic treatment.

• Wash your towels, face clothes, and bed linen at a high temperature. This will kill any bacteria. You should also keep these things separate from others who don’t have impetigo.