Impetigo: Symptoms, Treatment, and How to Stop It Spreading to Others
Medically reviewed by Dr. Celina Kazumi Iwasa, MD, Board-Certified Dermatologist · Last updated June 2026
Impetigo is the most common bacterial skin infection in children — and it's extraordinarily contagious. A child can wake up with a few small blisters around the mouth and, within days, spread the infection to their entire face, their siblings, and their classmates. The good news: impetigo is superficial, almost never serious, and responds quickly to treatment. The challenge: containing its spread in households and schools before it becomes a minor epidemic.
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Quick Answer
Impetigo is a highly contagious bacterial skin infection that most commonly affects infants and young children, though adults can also catch it. It typically appears as red sores around the nose and mouth that quickly burst, ooze fluid, and develop signature honey-colored crusts. Because it spreads easily through direct contact or shared items, prompt treatment with topical or oral antibiotics is important. With appropriate medical care and good hygiene, impetigo usually clears up quickly without leaving scars. Always consult a healthcare professional for an accurate diagnosis and treatment plan.
Symptoms
- Red sores that quickly rupture and ooze
- Honey-colored crusts over the sores
- Itching
- Painless fluid-filled blisters (bullous form)
- Sores that spread rapidly
- May be accompanied by swollen lymph nodes
Severity & Progression
What Causes Impetigo
Impetigo is caused by two bacteria: Staphylococcus aureus (responsible for the majority of cases in developed countries, including all bullous impetigo) and Group A Streptococcus (more common in tropical and developing regions).
The infection begins when bacteria enter through a break in the skin — a scratch, insect bite, eczema patch, or even a tiny abrasion invisible to the naked eye. The bacteria colonise the superficial epidermis and produce toxins that split the skin layers, creating the characteristic blisters and erosions. In bullous impetigo specifically, S. aureus produces exfoliative toxins that cleave desmoglein-1, the protein that holds the upper skin layers together.
Impetigo spreads through direct contact with lesions or nasal discharge (many carriers harbour the bacteria in their nose). Shared towels, clothing, and bedding can also transmit infection. Warm, humid weather, overcrowding, poor hygiene, and pre-existing skin conditions (especially eczema) increase risk.
There are two clinical forms: non-bullous impetigo (70% of cases) begins as small vesicles that rapidly rupture and form the diagnostic honey-coloured, 'stuck-on' crusts, typically around the nose and mouth. Bullous impetigo produces larger, fluid-filled blisters that are more fragile and rupture to leave shallow erosions with a collarette of scale at the border.
How Impetigo Differs from Similar Conditions
Several conditions can look similar. Here's how to tell them apart — though a healthcare professional can provide a definitive diagnosis.
| Condition | Key Difference from Impetigo |
|---|---|
| Cold Sores (Herpes Simplex) | Grouped, tense vesicles on the lips or vermillion border, preceded by tingling. Recurrent at the same site. Caused by HSV, not bacteria. Treated with antivirals, not antibiotics. |
| Contact Dermatitis | Itchy rather than tender. Distribution matches where something touched the skin. No honey-coloured crusts. |
| Eczema (Atopic Dermatitis) | Chronic, itchy, dry skin with a typical distribution. Can become secondarily infected with bacteria (impetiginised eczema) — in which case both the eczema and the infection need treatment simultaneously. |
| Ringworm | Ring-shaped with central clearing and a scaly border. No crusting. Fungal infection treated with antifungals. |
| Chickenpox | Widespread vesicles at different stages (vesicles, pustules, crusts simultaneously) with systemic symptoms (fever, malaise). Not localised to the face. |
Treatment: What Actually Works
Localised impetigo (fewer than 3 lesions, not spreading rapidly): Topical antibiotics are first-line. Mupirocin 2% ointment applied three times daily for 5 days is the most effective topical option. Fusidic acid (available in the UK, not the US) is an alternative. Retapamulin is a newer option for MRSA-associated cases.
Before applying antibiotic ointment, gently remove crusts by soaking with warm water and a clean cloth — this improves antibiotic penetration and speeds healing.
Widespread or rapidly spreading impetigo: Oral antibiotics are needed. Flucloxacillin (or dicloxacillin in the US) covers both Staphylococcus and Streptococcus. Cephalexin is an alternative. For penicillin-allergic patients: clarithromycin or erythromycin, though resistance rates are increasing. If MRSA is suspected: trimethoprim-sulfamethoxazole or doxycycline (the latter not for children under 12).
Preventing spread: Wash hands frequently. Don't share towels, flannels, or clothing. Keep nails short. Cover lesions loosely. Wash affected clothing and bedding in hot water. Children should stay home from school/nursery for 48 hours after starting antibiotics.
Complications are rare but include: post-streptococcal glomerulonephritis (kidney inflammation — more common in tropical regions with Streptococcal impetigo), ecthyma (a deeper ulcerative form), and rarely staphylococcal scalded skin syndrome (in neonates).
When Impetigo Is Actually Something Else
Honey-coloured crusts on a child's face are nearly diagnostic of impetigo. But if crusts don't respond to antibiotics, consider: herpes simplex (cold sores — grouped vesicles on the lip, recurrent), tinea faciei (scaly ring-shaped patches — fungal), or pemphigus foliaceus (rare in children). If impetigo keeps recurring, investigate for nasal carriage of Staphylococcus — applying mupirocin nasal ointment can break the cycle.
Impetigo Across Skin Types and Hair Types
In darker skin, the erythema surrounding impetigo lesions may be subtle or appear as hyperpigmentation. The honey-coloured crusts themselves remain visible across all skin tones and are the most reliable diagnostic feature. Post-inflammatory hyperpigmentation is common after impetigo resolves in darker-skinned children and can persist for weeks to months, causing parental concern. Reassurance that this will fade is important — no additional treatment is needed for the pigment changes.
Self-Care Tips
- Wash affected areas gently with soap and water
- Cover sores with bandages
- Wash hands frequently
- Don't share towels, clothing, or bedding
- Keep children home until 24 hours after starting antibiotics
- Cut fingernails short to prevent scratching
When to See a Doctor
If sores are spreading, not improving after a few days of treatment, or if there's fever or signs of deeper infection
Frequently Asked Questions
What do the early signs of impetigo look like?
Impetigo usually starts as clusters of small, itchy red sores or painless, fluid-filled blisters. These sores burst quickly, oozing fluid that dries to form distinctive honey-colored or yellowish crusts. The crusts are most often seen on the face, specifically around the nose and mouth, but can also appear on the hands, feet, or areas where the skin was already broken.
How do children usually catch impetigo?
The infection is caused by bacteria, most commonly Staphylococcus aureus or Group A Streptococcus. It spreads very easily through close physical contact with someone who is infected, or by touching contaminated objects like shared toys, towels, and bedding. The bacteria often enter the body through minor skin breaks, such as cuts, scrapes, eczema patches, or insect bites.
How is this skin infection typically treated?
Treatment depends on how widespread the sores are. A doctor will often prescribe a topical antibiotic ointment to apply directly to a small number of sores. If the infection has spread over a larger area or causes a fever, oral antibiotics may be necessary. It is important to gently wash the crusts with soap and water and complete the full course of medication prescribed by your doctor.
When is it safe for my child to go back to school or daycare?
Impetigo is highly contagious, so infected children should be kept home from school or daycare to prevent spreading the bacteria to others. Once they have started antibiotic treatment—whether localized ointments or oral pills—they can generally return exactly 24 hours after the first dose. Until then, keep the sores covered with clean bandages and ensure they practice good handwashing.
What can I do at home to stop it from spreading to the rest of the family?
Strict hygiene is the best way to stop the spread. Wash the affected areas gently with soap and water, and keep the sores covered with bandages. Do not share towels, washcloths, clothing, or bedding with the infected person. Keep their fingernails cut short to prevent scratching, which can spread the bacteria to other parts of their own body. Wash everyone's hands frequently.
When should I take my child to the doctor for impetigo?
You should see a doctor if you suspect impetigo to get a proper diagnosis and prescription treatment. Seek immediate medical attention if the sores are spreading rapidly, do not start healing after a few days of antibiotics, or if the child develops a fever. You should also watch for increased redness or warmth around the sores, which could indicate a deeper infection like cellulitis.
Will my child have permanent scars from these sores?
In most cases, impetigo does not leave permanent scars. The scabs and honey-colored crusts can look quite severe, but the infection typically only affects the top layer of the skin. Once healed, there might be a temporary red or pink mark that fades over time. Preventing your child from picking or violently scratching at the crusts will help ensure the skin heals smoothly.
How can ScanSkinAI help with impetigo?
ScanSkinAI can be a helpful screening aid by analyzing photos of your child's skin and pointing out visual similarities to common bacterial infections like impetigo. However, it is an educational tool, not a diagnostic one. Because skin infections can spread rapidly and require prescription antibiotics, always consult a qualified healthcare provider for an official diagnosis and appropriate medical treatment.
Related Symptoms
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Related Conditions
Medical References
Information on this page is sourced from and verified against reputable medical resources:
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Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. The content on this page should not be used to diagnose or treat any health problem. Always consult with a qualified healthcare professional for proper medical evaluation, diagnosis, and treatment of your condition.