Healing stages of impetigo

Impetigo – Infected Sores

Is this your child’s symptom?

  • Coin-shaped sores on the skin covered by scabs
  • The infected crusts are the color of honey
  • Skin infection caused by a bacteria

Symptoms of Impetigo

  • Sores smaller than 1 inch (2.5 cm)
  • Often covered by a soft, yellow-brown scab or crust
  • Scabs may drain pus or yellow fluid off and on
  • Starts as small red bumps. These change quickly to cloudy blisters or pimples. Then, they become open sores which drain fluid or pus.
  • Sores increase in size
  • Any sore or wound that grows and doesn’t heal is usually impetigo.

Cause of Impetigo

  • A skin infection caused by a bacteria. It starts in a small break in the skin. Examples are a scratch or insect bite.
  • The most common bacteria are Staph and Strep. If the child has a sore throat, they may also have Strep throat. A rapid Strep test will give the answer.
  • Impetigo often spreads and increases in number from scratching.

When to Call for Impetigo – Infected Sores

Call Doctor or Seek Care Now

  • Pink or tea-colored urine
  • Fever and spreading redness around the impetigo
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Spreading redness around the impetigo and no fever
  • Fever or sore throat are present
  • Sore is larger than 1 inch (2.5 cm) across
  • Sores and crusts inside the nose
  • Impetigo gets worse after 48 hours on antibiotic ointment
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Impetigo in 2 or more children (such as siblings or play groups)
  • Child plays contact sports. Reason: to prevent spread.
  • 3 or more impetigo sores. Reason: may need an oral antibiotic. Many of these children also have a Strep throat.
  • Not healed up after 1 week on antibiotic ointment
  • You have other questions or concerns

Self Care at Home

  • Mild impetigo (1 or 2 sores that started with a scratch or insect bite)

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice for Impetigo

  1. What You Should Know About Impetigo:
    • Impetigo is a skin infection. Most often, it starts in a scratch or insect bite.
    • It usually responds to treatment with any antibiotic ointment.
    • Here is some care advice that should help.
  2. Remove Scabs:
    • Soak off the scab using soap and warm water. The bacteria live underneath the scab.
  3. Antibiotic Ointment:
    • Put an antibiotic ointment (such as Polysporin) on the sores. No prescription is needed. You can also use one you already have.
    • Do this 3 times per day.
    • Cover it with a bandage (such as Band-Aid) to prevent scratching and spread.
    • Repeat the washing, ointment and dressing 3 times per day.
  4. Do Not Pick at the Sores:
    • Help your child not to scratch and pick at the sores. This spreads the impetigo.
  5. Return to School:
    • Impetigo is spread to others by contact with skin lesions.
    • Wash the hands often. Try not to touch the sores.
    • For mild impetigo (1 or 2 sores), can go to school if it is covered.
    • For severe impetigo, child needs to take an oral antibiotic for more than 24 hours. Then your child can go back to school.
    • Contact Sports. In general, needs to be on antibiotics for 3 days before returning to sports. There must be no pus or drainage. Check with the team’s trainer if there is one.
  6. What to Expect:
    • Sore stops growing in 1 to 2 days.
    • The skin is healed in 1 week.
  7. Call Your Doctor If:
    • Impetigo sore gets bigger after 48 hours on antibiotic ointment
    • Gets new impetigo sore on antibiotic ointment
    • Not healed up in 1 week
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 02/01/2020

Last Revised: 03/14/2019

Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.

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Research on how effective the different treatments are

To compare the effectiveness of different treatment options, researchers from the Cochrane Collaboration (an international network of researchers) gathered and systematically analyzed all the relevant studies in this area. These studies looked at the effectiveness of disinfectant or antibiotic solutions and creams, as well as antibiotic tablets, in the treatment of impetigo. Most of this research only looked at people who had impetigo on smaller areas of skin – so their symptoms affected a limited area.

The studies showed that creams containing antibiotic medication – such as mupirocin, fusidic acid or retapamulin – relieved the symptoms better than ointments that didn’t contain any antibiotic medication (placebos). Mupirocin cream was the most commonly tested antibiotic. The studies on mupirocin found the following:

  • Without treatment: Symptoms improved or cleared up after 7 to 12 days in about 35 out of 100 people who used a placebo (fake medication).
  • With treatment: Symptoms improved or cleared up after 7 to 12 days in about 75 out of 100 people who used the mupirocin cream.

In other words: By treating impetigo with the mupirocin cream, it cleared up faster in 40 out of 100 people.

Only about 170 people participated in the studies, though, so the figures only allow a rough estimate of what can be expected from antibiotic creams.

Compared with tablets containing the antibiotic erythromycin, mupirocin ointment was also somewhat more effective against impetigo covering smaller areas of skin. Antibiotic tablets were more likely to cause side effects such as nausea, vomiting, stomach ache and diarrhea. In the studies, about 25 out of 100 people who took the erythromycin tablets had these kinds of side effects, but only 5 out of 100 people who used mupirocin cream did.

There were no studies suitable for answering the question of whether antibiotic tablets are more effective than creams when treating impetigo affecting larger or several areas of the body. It is also not clear if disinfectant solutions or creams can help in the treatment of impetigo.

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Impi-what? Impetigo (say: im-pih-TIE-go) is a strange-sounding word that may be new to you. It’s an infection of the skin caused by bacteria. Impetigo is commonly found on the face, often around the nose and mouth. But it can show up anywhere the skin has been broken.

If you have a cut or scrape or if you scratch your skin because of a bug bite, eczema, or poison ivy, germs may find a way to get inside. Once inside, the bacteria cause small blisters on the skin. These blisters burst and ooze fluid that crusts over, a condition called impetigo.

Kids seem to get it more than adults do, but impetigo can affect anyone.

We all have bacteria living on our skin and in our nose, but most of the time they don’t cause any trouble. Two types of bacteria can cause impetigo: group A streptococcus (say strep-toe-KAH-kus) and Staphylococcus aureus (say: stah-fih-lo-KAH-kus OR-ee-us). It doesn’t matter which bacteria cause someone’s impetigo — the treatment is almost the same.

How Do I Know if I Have It?

Impetigo usually starts as small blisters that burst and ooze fluid that crusts over. The crust is yellow-brown, or honey-colored, making impetigo look different from other scabs.

Another kind of impetigo affects babies and younger kids more than older kids. In this type, the blisters are larger and take longer to burst. The fluid in these blisters may start out clear and then turn cloudy.

What Will the Doctor Do?

If you and your parents think you have impetigo, you should see a doctor. A doctor usually can tell if you have impetigo by examining your skin. If you have mild impetigo, your doctor probably will prescribe an antibiotic ointment, which gets put right on your skin. An antibiotic is a type of medicine that attacks bacteria.

If the impetigo has spread to a few places or if the antibiotic ointment is not working, you may need to take an antibiotic pill or liquid for about 10 days. Remember: It’s important to finish ALL of the medicine, even if the spots clear up quickly.

What Can I Do?

Impetigo might itch, but try not to scratch or touch the sores. Touching them can spread the sores to other parts of your body or to someone else. If you do touch the area, be sure to wash your hands right away.

Your mom or dad can help you apply the ointment or take the medicine your doctor prescribed. Your parent also can help you gently wash the infected areas with mild soap and water, using a piece of clean gauze.

If a sore is very crusted, you can soak it in warm, soapy water to loosen the crust. You don’t have to get it all off, but try to keep it clean. Your parent also might help you cover the sores with gauze and tape or a loose plastic bandage.

Impetigo is contagious, which means that you could spread it to other people. That’s why people with impetigo should keep the sores covered when they go to school or other public places. After you take the medicine for least 24 hours, the impetigo isn’t contagious anymore. After 3 days, the sores should begin to heal.

Your mom or dad should call the doctor if you develop a fever or if you don’t get better after taking the medicine for a few days. Your parent should call the doctor right away if skin around the impetigo sore becomes red, warm, swollen, or painful if you touch it.

Can I Prevent Impetigo?

If someone in your family or a friend has impetigo, don’t touch that person’s skin. Also steer clear of his or her clothes, towels, sheets, and pillows. The bacteria that cause impetigo can live on all these things. Your parent should wash these items in very hot water.

And here are some good habits that can help you avoid getting impetigo in the first place:

  • Take a bath or shower regularly.
  • Use soap to keep your skin clean.
  • Watch out for skin that’s scraped or irritated, like a mosquito bite. Keep those areas clean and covered and don’t scratch.
  • Wash your hands regularly with soap.
  • Keep your nails short and clean.

Reviewed by: Joanne Murren-Boezem, MD Date reviewed: June 2018

When to Seek Medical Care

Seek care for any infection that is not improving. If the infection is moderate to severe or there is fever or pain, seek medical attention.
If you are currently being treated for a skin infection that has not improved after 2–3 days of antibiotics, return to your doctor.
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a strain of “staph” bacteria resistant to antibiotics in the penicillin family, which have been the cornerstone of antibiotic therapy for staph and skin infections for decades. CA-MRSA previously infected only small segments of the population, such as health care workers and persons using injection drugs. However, CA-MRSA is now a common cause of skin infections in the general population. While CA-MRSA bacteria are resistant to penicillin and penicillin-related antibiotics, most staph infections with CA-MRSA can be easily treated by health care practitioners using local skin care and commonly available non-penicillin-family antibiotics. Rarely, CA-MRSA can cause serious skin and soft tissue (deeper) infections. Staph infections typically start as small red bumps or pus-filled bumps, which can rapidly turn into deep, painful sores. If you see a red bump or pus-filled bump on the skin that is worsening or showing any signs of infection (ie, the area becomes increasingly painful, red, or swollen), see your doctor right away. Many people believe incorrectly that these bumps are the result of a spider bite when they arrive at the doctor’s office. Your doctor may need to test (culture) infected skin for MRSA before starting antibiotics. If you have a skin problem that resembles a CA-MRSA infection or a culture that is positive for MRSA, your doctor may need to provide local skin care and prescribe oral antibiotics. To prevent spread of infection to others, infected wounds, hands, and other exposed body areas should be kept clean and wounds should be covered during therapy.

Summit Medical Group Web Site

What is impetigo?

Impetigo is an infection of the skin. Any wound that doesn’t heal, or a wound that increases in size, usually has become infected.

The infected sores:

  • Are less than 1 inch in diameter
  • Start as small red bumps, which rapidly change to cloudy blisters, then pimples, and finally sores
  • Are often covered by a soft, yellow-brown scab
  • May cause swollen lymph glands in the area near the sores
  • May be draining pus

Impetigo often spreads and the sores increase in number from scratching and picking at the initial sore.

What is the cause?

Impetigo is caused by Streptococcus bacteria or Staphylococcus bacteria. It is more common in the summertime when the skin is often broken by cuts, scrapes, and insect bites. It is also spread by close contact with the sores of someone who is infected or with items they have touched, such as clothing and toys. When caused by a strep infection of the nose, the impetigo usually first appears near the nose or mouth.

How long does it last?

With proper treatment, the skin will be completely healed in 1 week. Some blemishes will remain for 6 to 12 months, but scars don’t occur unless your child repeatedly picks his sores. The sores are not contagious if they are covered, or after your child has taken an antibiotic for 24 hours.

How can I take care of my child?

  • Oral antibiotic

    Some children with impetigo need an oral antibiotic prescribed by their healthcare provider.

    1 or 2 sores that develop after an insect bite or cut may need only an antibiotic ointment.

  • Antibiotic ointment

    You can buy antibiotic ointment without a prescription. Before you first apply the antibiotic ointment, remove the scab. Apply the antibiotic ointment to the raw surface 3 times a day. Cover the sores with a Band-Aid to prevent scratching and spread. Apply the ointment for 7 days, or longer if necessary. Wash off the area with warm water each time before you apply the ointment. Any new crust that forms should not be removed because this delays healing.

  • Removing the scabs

    The bacteria live underneath the soft scabs, and until these are removed, the antibiotic ointment has difficulty getting through to the bacteria to kill them. Soak the area for 15 to 20 minutes in warm soapy water. Use a liquid antibacterial soap. Then gently remove the crusts. The area may need to be gently rubbed, but it should not be scrubbed. A little bleeding is common if you remove all the crust. You usually only need to do this before the first application of antibiotic ointment.

  • Preventing the spread of impetigo to other areas on your child’s body

    Every time your child touches the impetigo and then scratches another part of the skin with that finger, he can start a new site of impetigo. To prevent this, encourage your child not to touch or pick at the sores. Keep his fingernails cut short, and wash his hands often with one of the antibacterial soaps. Cover the sores with a Band-Aid if they are not on the face.

  • Contagiousness to others

    Impetigo is quite contagious. Be certain that other people in the family do not use your child’s towel or washcloth. It can also be spread by toys and athletic equipment your child handles. Your child should be kept out of school until he has been on treatment for 24 hours with oral antibiotics or 48 hours with antibiotic ointment alone. For mild impetigo treated with an antibiotic ointment, the child can continue to attend day care or school if the sore is covered with a Band-Aid.

When should I call my child’s healthcare provider?

Call IMMEDIATELY if:

  • Your child starts to act very sick.

Call within 24 hours if:

  • The size and number of sores increase after 48 hours of treatment.
  • A fever or a sore throat occurs.
  • The impetigo is not completely healed in 1 week.
  • You have other questions or concerns.

What is impetigo?

Impetigo is a skin infection caused by bacteria. It is more common in children than in adults. Impetigo is usually a mild infection but it can spread and cause serious illness if it is not treated.

How does it occur?

Impetigo is caused by bacteria. The 2 types of bacteria that cause the infection are called Staphylococcus aureus and Streptococcus pyogenes (Group A streptococcus). These bacteria can live on your skin without hurting you. However, if they get into a wound, they may cause an infection.

Impetigo is more likely to happen if you have a chronic skin condition like eczema, or when you have a scratch, scrape, insect bite, or other skin irritation that causes a break in the skin. Impetigo is more common when it is hot and humid. It is very contagious. Physical contact, including scratching, can spread the infection to other parts of the body or to other people. It can also be spread by contaminated clothing, athletic equipment, towels, bed linen, and toys.

What are the symptoms?

Impetigo can occur on any area of skin. It often appears on the face between the upper lip and nose. The infection begins as small blisters. The blisters form pus inside and then break open. The pus from the blisters dries as a gold or yellow-colored crust. The blisters or sores are painless.

How is it diagnosed?

Your healthcare provider will look at the blisters or sores on your skin. Impetigo can often be diagnosed without any tests. In some cases your provider may remove a small bit of material from one of the sores for lab tests to identify the bacteria.

How is it treated?

The treatment depends on your age and the severity and type of infection that you have. If the infection is mild, all you may need to do is keep your skin clean so the infection can heal on its own. Your healthcare provider may prescribe an antibiotic ointment to put on your skin.

You may need to put some of the antibiotic ointment inside your nose. Some people carry the bacteria inside their nose and the infection may come back if the nose is not treated.

For larger or more serious infections, your provider may prescribe an oral antibiotic medicine or give you a shot of antibiotic medicine.

How long will the effects last?

The sores should begin to heal within 2 to 5 days after you start using an antibiotic. If you are taking an oral antibiotic, the infection usually stops being contagious after 24 hours of treatment. If you are using an antibiotic ointment instead, the sores will no longer be contagious when they stop oozing and are drying up.

How can I help take care of myself?

Follow these tips to ease the discomfort of impetigo:

  • Gently wash the infected area with antibacterial soap. Soak the area for 15 to 20 minutes in warm soapy water. Then gently remove the crusts.
  • Cover the sores with a gauze bandage to keep the infection from spreading and to prevent scratching.
  • Shave around sores, not over them.
  • Avoid touching the sores more than necessary.

If your provider prescribed an antibiotic ointment, gently pat your skin dry after you wash the infected area and put a thin layer of antibiotic ointment on it with a cotton swab (Q-Tip). Do not touch the tube of antibiotic ointment to the infected area. Also do not touch the ointment tube with the used cotton swab. If you need more ointment, use a new cotton swab. Do not use the ointment more often than directed. Wash your hands thoroughly after using this medicine.

If your provider prescribed an antibiotic to take by mouth, take all of it exactly as directed by your provider. If you stop taking the medicine too soon, the infection may not be completely gone yet or it may return.

Call your healthcare provider if:

  • You develop a fever.
  • Your skin does not begin to heal after 3 days of treatment.

How can I help prevent impetigo?

  • Wash cuts and scratches, insect bites, or other breaks in the skin with warm water and soap right away to prevent infection. Cover the area with an adhesive bandage (Band-Aid).
  • Wash your hands often with warm water and soap for at least 15 seconds.
  • Do not share washcloths, towels, clothing, bath water, or personal items like razors or combs.
  • Use hot, soapy water to wash clothes and linens. Dry clothes on the hot setting if you use an automatic dryer.
  • Shower or bathe using soap every day and after strenuous exercise.

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Published by RelayHealth.
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
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