What is impetigo?

Impetigo (im-pet-eye-go) is a skin infection caused by Staphylococcus (staph) or Streptococcus bacteria. Some people call it ‘school sores’ because it is most common in school-aged children and causes skin sores that easily spread from one child to another.

In most cases, impetigo develops when bacteria get into the body through a scratch, bite, or due to another condition that affects the skin, such as eczema. Occasionally, it can affect people with healthy skin.

Although impetigo can look quite serious, it is usually a mild infection that is easy to treat and tends to clear after a few days of treatment. It generally will not get better on its own and can spread quickly.

Signs and symptoms of impetigo

Most cases of impetigo follow the same pattern:

1. One or more sores appear on the skin; they often look like blisters and feel itchy.
2. The sores turn red and burst, weeping liquid.
3. When the sores stop weeping, the liquid dries and leaves a tan or yellow-coloured crust, as if they are covered in honey.
4. Other spots may appear around the first ones and spread outwards.

The sores can grow anywhere, but the most common places are around the mouth and nose, or arms and legs. As they are itchy, children may want to scratch them – this can spread the infection to the surrounding skin and other parts of the body.

Children with impetigo do not usually have a fever (temperature of 38°C or more) or feel unwell.

Figure one: Two images of children with impetigo – one with impetigo around the mouth (perioral impetigo) and one with impetigo on the leg.

Is impetigo contagious?

Impetigo is very contagious. It usually spreads through skin contact with the fluid or crusts of an impetigo sore, which contain the bacteria. For example, by touching a sore directly or things that have been on a sore, such as clothes or towels.

An impetigo sore can be infectious for as long as it is weeping. It will usually stop being infectious about 24 hours after starting antibiotic treatment, once it has started healing.

It usually takes between one and three days for a sore to develop after contact with fluid or crusts from someone with impetigo.

Reducing the spread of impetigo

There are some things you can do to reduce the risk of your child getting impetigo and limit the spread of the infection if it develops.

• Keep your child’s skin healthy.
  • Wash and cover any cuts, scratches, or bites.
  • Treat any dry or cracked skin with a gentle, unscented moisturiser.
  • Care for existing skin conditions – do not let them go untreated.
  • Put petroleum jelly on open skin under a runny nose.
• Practise good hygiene and teach your child to do the same.
  • Daily baths or showers with soap reduce the risk of impetigo.
    • You can use antiseptic soaps or body washes, but they irritate some people’s skin.
    • Do not let your child share a bath with other children to stop the infection spreading.
  • Wash your hands with soap every time you bathe your child, apply cream or ointment, or touch the infected area.
  • Always throw away used tissues.
  • Cut your child's fingernails short and keep them clean.

If your child has impetigo:

• Wash their clothes, towels, and bed linen separately from the rest of the family.
  • Use hot water and dry everything in the sunshine or in a hot tumble dryer.
• Clean all toys using a mild disinfectant.
• Put all dressings from impetigo sores in a bin with a lid as soon as you take them off and wash your hands with soap.

How to care for impetigo

See a doctor

Take your child to see their doctor if you think they have impetigo. They may prescribe antibiotics in the form of a cream, ointment, tablets, or syrup. Give these to your child as directed, and make sure you continue the treatment until all sores have healed.

Care at home

Your child’s impetigo sores should clear up in a few days with treatment.

• Gently remove the crusts from your child’s sores whenever they appear.
  • This will reduce the number of bacteria on the skin and allow any creams or ointments to reach the infection.
    • For sores on the face, wet a clean, disposable cloth and gently wipe the crusts to remove them.
    • For sores on the body, soak your child in a bleach bath for 10 minutes while wiping the crusts away with a clean, wet disposable cloth.
    • Do not reuse the cloth wipes.
• A 10-minute bleach bath will reduce the amount of bacteria on your child's skin and the risk of the impetigo spots spreading.
  • To make a safe bleach bath, use regular household bleach with 4% chlorine and add 12mL of bleach for every 10L of water. This is safe for children; the amount of bleach in the water is less than in a swimming pool.
  • You can shower your child using the antiseptic, chlorhexidine, if you do not have a bath. Most pharmacies sell chlorhexidine body wash.
  • For troublesome impetigo or infections that keep coming back, twice-weekly bleach baths may help.
• Stop your child from scratching their sores as much as possible. This will help prevent scarring, bleeding, and spreading the infection.
  • You can cover their sores with a breathable dressing if they cannot stop scratching them.
  • Scratching impetigo sores can trap bacteria under the fingernails; if your child touches other parts of their body, they may spread the infection.

When to get help