Health A to Z
Impetigo is a common and highly contagious skin infection that causes sores and blisters. It's not usually serious and often improves within a week of treatment or within a few weeks without treatment.
Impetigo is the most common skin infection in young children in the UK, but it can affect people of all ages.
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There are two types of impetigo:
The symptoms of both types are described below.
The symptoms of non-bullous impetigo begin with the appearance of red sores – usually around the nose and mouth but other areas of the face and the limbs can also be affected.
The sores quickly burst leaving behind thick, golden crusts typically around 2cm across. The appearance of these crusts is sometimes likened to cornflakes stuck to the skin.
After the crusts dry, they leave a red mark that usually fades without scarring. The time it takes for the redness to disappear can vary between a few days and a few weeks.
The sores aren't painful, but they may be itchy. It's important not to touch or scratch the sores because this can spread the infection to other parts of the body, and to other people.
Other symptoms, such as a high temperature (fever) and swollen glands, are rare but can occur in more severe cases.
The symptoms of bullous impetigo begin with the appearance of fluid-filled blisters (bullae) which usually occur on the central part of the body between the waist and neck, or on the arms and legs. The blisters are usually about 1-2cm across.
The blisters may quickly spread, before bursting after several days to leave a yellow crust that usually heals without leaving any scarring.
The blisters may be painful and the area of skin surrounding them may be itchy. As with non-bullous impetigo, it's important not to touch or scratch the affected areas of the skin.
Symptoms of fever and swollen glands are more common in cases of bullous impetigo.
Speak to your GP if you think you or your child may have symptoms of impetigo.
Impetigo isn't usually serious, but it can sometimes have similar symptoms to more serious conditions such as cellulitis (an infection of the deeper layers of skin) so it's important to get a correct diagnosis.
Your GP can also prescribe treatment to help clear up the infection more quickly than if it was left untreated.
The bacteria can infect the skin in two main ways:
The bacteria can be spread easily through close contact with someone who has the infection, such as through direct physical contact, or by sharing towels or flannels.
As the condition doesn't cause any symptoms until four to 10 days after initial exposure to the bacteria, it's often easily spread to others unintentionally.
Impetigo usually gets better without treatment in around two to three weeks.
However, treatment is often recommended because it can reduce the length of the illness to around seven to 10 days and can lower the risk of the infection being spread to others.
The main treatments prescribed are antibiotic creams or antibiotic tablets. These usually have to be used for around a week.
Read about treating impetigo.
During treatment, it's important to take precautions to minimise the risk of impetigo spreading to other people or to other areas of the body.
Most people are no longer contagious after 48 hours of treatment or once their sores have dried and healed. It's important to stay away from work, school, nursery or playgroup until this point.
The advice below can also help to prevent the spread of the infection:
If you think that the infection has spread to someone else, make sure they're seen by a GP as soon as possible.
To reduce the risk of impetigo returning, make sure any cuts, scratches or bites are kept clean. Ensure any condition that causes broken skin, such as eczema, is treated promptly.
If you develop impetigo frequently, your doctor may suggest taking a swab from around your nose to see if you carry staphylococcal bacteria. These bacteria can live in the noses of some people without causing problems, although they can lead to impetigo if they infect broken skin nearby.
If you're found to carry these bacteria, you may be prescribed an antiseptic nasal cream to apply several times a day for five to 10 days in an attempt to clear the bacteria and reduce the chances of impetigo recurring.
Complications of impetigo are rare, but they can sometimes occur and can be serious. Tell your GP if you have impetigo and your symptoms change or get worse.
Some complications associated with impetigo include:
In very rare cases, impetigo may lead to some scarring, particularly if you scratch at the blisters, crusts or sores.
Impetigo isn't usually serious and often clears up without treatment after two to three weeks.
Treatment is often recommended as it can help clear up the infection in around seven to 10 days and reduce the risk of the infection being passed on to others.
If impetigo is confirmed, it can usually be effectively treated with antibiotics.
If the infection is being caused by an underlying skin condition, such as eczema, this may also need to be treated.
For mild cases of impetigo that cover a small area, antibiotic cream is often recommended. This usually needs to be applied three or four times a day for seven days.
Before applying the cream, wash any affected areas of skin with warm, soapy water and try to clean off any crusts that have developed.
To reduce the risk of spreading the infection, it's also important that you wash your hands immediately after applying the cream or, if available, wear latex gloves while applying the cream.
Side effects of antibiotic cream can include:
If symptoms haven't improved after seven days of starting treatment, speak to your GP about other possible treatment options.
Antibiotic tablets may be prescribed if the infection is more severe and widespread, or if the symptoms don't improve after using antibiotic cream. These usually need to be taken two to four times a day for seven days.
If a course of oral antibiotics is prescribed for you or your child, it's very important that the course is finished even if the symptoms clear up before you've taken all the tablets.
Common side effects of oral antibiotics include:
Speak to your GP if your symptoms haven't improved after seven days of treatment with antibiotic tablets.
Further tests are usually only required in cases where the infection is severe or widespread, doesn't respond to treatment, or keeps recurring.
In these circumstances, your GP may refer you to a dermatologist (skin specialist) for further tests or they may take a swab of the affected skin themselves for testing.
This can help to rule out or confirm other skin conditions that may be responsible for your symptoms and can detect whether you carry one of the types of bacteria responsible for the infection inside your nose.
If your doctor thinks you may keep getting impetigo because you naturally have these bacteria inside your nose, they may prescribe you an antiseptic nasal cream to try to clear the bacteria.
When Marilyn's son had to be treated for impetigo at the age of nine, she thought that would be the end of it. But a mix-up of the bathroom flannels meant it soon spread to her daughter and 11-month-old son.
"At first I thought Callum had chickenpox because I noticed he had seven or eight spots on his face. They looked rotten, and he complained that they were really itchy.
"He'd just been treated for impetigo on his groin, but the facial spots didn't look the same – until they crusted over and started weeping. I knew then it wasn't chickenpox, and took him to the GP to get it checked out.
"The GP said Callum's impetigo had spread to his face, and gave me some more antibiotic cream to treat it. He told me to separate my children's flannels and towels as the infection spreads so easily. But it was too late.
"I think the kids got their flannels mixed up, because, by then, my ten-year-old daughter Sinead had caught it too. Then they passed it to their baby brother.
"I had them all treated with antibiotics that Monday, and by Friday the spots had gone completely.
"Luckily it was the holidays, so I didn't need to keep them off school. For the first few days of treatment, when the spots were still weeping, I kept them inside and they played together in the house. During this time I constantly had to remind them to stop scratching their spots.
"My daughter got a bit moody about not seeing her friends during those days, but they coped fine otherwise and are clear of impetigo now."