Impetigo

What is impetigo?

Impetigo (pronounced “im-peh-TIE-go”) is an itchy, sometimes painful, skin infection. When your child gets a cut, bite or scratch that opens their skin, bacteria can enter and cause a bacterial infection. But impetigo can infect skin even if it’s not broken or punctured.

Impetigo happens more often in warmer months when children are outside. Typically, the first signs of impetigo are sores and blisters on your child’s mouth and nose. It can also appear on your child’s scalp, hairline, legs and arms.

Types of impetigo

There are a few different types of impetigo, including non-bullous, bullous and ecthyma.

Non-bullous impetigo

Non-bullous is early-stage impetigo. It’s the most common type. The non-bullous impetigo early stages include:

1. Developing one or more itchy sores that quickly burst.
2. Red or raw skin where sores have broken open.
3. Swollen glands near the sores.
4. Forming honey-colored crusts over the sores, but the skin eventually heals without scarring.

Bullous impetigo

Bullous impetigo is a rarer type of skin infection. It’s more common in infants. More than 90% of cases of bullous impetigo affect children younger than age 2. The stages of this type include:

1. Large, fluid-filled blisters form on your child’s skin, but no redness appears around the surrounding skin.
2. The blisters become clear and limp and then break open.
3. Crusty sores form on your child’s skin, and their skin heals without scarring.

Ecthyma

Untreated impetigo can develop into ecthyma. Ecthyma is a more serious type of skin infection. It goes deeper into your child’s skin. The stages typically include:

1. Painful blisters form on your child’s skin that turn into deep, open sores.
2. Thick crusts develop on your child’s skin, and redness often appears near the surrounding skin.
3. After your child’s skin heals, scars may form because the infection went deeper into their skin.

How common is impetigo?

Impetigo is the most common skin infection in kids between the ages of 2 and 5. Older children can also get it. It accounts for about 10% of skin conditions in children.

Can adults get impetigo?

Yes, impetigo can affect adults. In adults, the condition may occur after another skin issue. Sometimes it develops after you’ve had a cold or another virus. You may be at higher risk if you:

• Live in a tropical climate with hot, humid summers and mild winters.
• Have a scabies infection.
• Participate in skin-to-skin contact sports where cuts and scrapes are common.
• Live in close contact with others. Infections often occur among people living in the same house.

Impetigo vs. cold sore

Impetigo and cold sores are both common skin infections that can cause blisters. Cold sores usually occur around your mouth and consist of small blisters. Impetigo can form around your mouth but also on other parts of your face and body. It causes larger blisters. A bacteria causes impetigo, whereas cold sores are a symptom of the herpes simplex virus (HSV).

Impetigo vs. weeping eczema

Impetigo and weeping eczema are both common skin conditions. Impetigo is a type of skin infection, whereas eczema is a type of dermatitis. Impetigo causes crusty, honey-colored sores and blisters. Weeping eczema sometimes causes blisters with clear or straw-colored fluid. The blisters may be purple or red and they can ooze or “weep” the fluid.

When do impetigo symptoms start?

Typically, symptoms of impetigo develop within three days once the bacteria infect your child’s skin. Impetigo on the face starts around the mouth and nose. However, impetigo on the scalp or hairline can also occur.

What does impetigo look like?

Impetigo includes blisters, rashes and other skin wounds (lesions). The condition includes the following characteristics:

• Impetigo blisters may be pus-filled and burst easily. The fluid may be yellow or tan and it may seep out and form a crust.
• Impetigo rash can spread and cause red, raw skin.
• Skin lesions on your child’s lips, nose, ears, arms and legs may appear. The lesions can spread to other parts of their body.
• Swollen lymph nodes near the infected area may develop.

If you or your child has impetigo caused by Staph bacteria, you may notice:

• Reddish skin surrounding red blisters, full of liquid or pus that eventually looks cloudy.
• Blisters that burst easily and leak.
• Raw, shiny areas that scab over with a yellowish-brown crust.

What causes impetigo?

Impetigo causes include certain types of bacteria that lead to infection. The most common impetigo bacteria include:

• Staphylococcus aureus (S. aureus or “staph”): S. aureus causes 80% of non-bullous impetigo cases.
• Group A streptococcus (“strep”): Group A strep causes 10% of non-bullous cases.

The bacteria usually enter your child’s skin through a cut, scrape, rash or insect bite. After they enter your child’s body, the bacteria continue growing in their skin. This can lead to inflammation and infection in the top layers of your child’s skin.

Your child may also get impetigo by scratching something itchy on their skin, such as chickenpox or eczema. When they scratch, it breaks the skin, making it easy for bacteria to get in.

Impetigo may also occur without any skin breakage. Instead, it can occur after you’ve experienced another skin condition, such as:

• Head lice.
• Scabies.
• Eczema.

Adults can also get impetigo through health conditions such as tattoo infections.

Can stress cause impetigo in adults?

No, stress doesn’t cause impetigo. However, stress can weaken your immune system. With a weakened immune system, it’s easier for bacteria to infect you and harder for your body to fight them.

Is impetigo contagious?

Impetigo is highly contagious. Most people get it through direct skin-to-skin contact. You can get impetigo by coming into contact with sores, mucus or nasal discharge from someone who has it. Children and athletes, such as football players and wrestlers, often get it this way.

People can also spread impetigo by sharing items such as towels, clothing or other personal items with an infected person.

How long is impetigo contagious?

Without treatment, impetigo can be contagious for weeks. After starting impetigo treatment, the condition is contagious until:

• The rash disappears.
• Scabs fall off.
• You’ve finished at least two days of antibiotics.

What are the complications of impetigo?

Complications are rare. Certain strains of strep bacteria that cause impetigo can also cause glomerulonephritis. This inflammatory kidney disease can produce high blood pressure and blood in your pee (hematuria). Other complications of impetigo may include:

• The rash spreading to deeper skin layers.
• The bacterial infection spreading to other parts of your body.
• Permanent skin damage and/or scarring.

How is impetigo diagnosed?

A healthcare provider will diagnose impetigo based on how your child’s sores look. They may take a skin culture to send to a laboratory. This will help your provider determine the right antibiotic to prescribe your child.

How do you treat impetigo?

Impetigo treatment includes antibiotics. A provider may prescribe topical antibiotics to put directly on your child’s skin. Impetigo treatments may also include an oral antibiotic (a liquid or pill taken by mouth) if the impetigo covers a large area of your child’s skin or multiple body parts.

Impetigo medication may include:

• Topical mupirocin (Bactroban® or Centany®) ointment.
• Oral antibiotics such as cephalosporins, clindamycin (Cleocin®) and sulfamethoxazole (Bactrim™).

How to get rid of impetigo in 24 hours

Impetigo won’t go away for everyone in 24 hours. However, some studies have shown that the condition goes away quicker when you use an antibiotic cream. Providers recommend these creams to help the symptoms go away fast and to help stop the infection from spreading. Therefore, the sooner you receive treatment, the better.

What impetigo treatments are over-the-counter?

You’ll need prescription antibiotic medication to treat most forms of impetigo. For minor skin infections that haven’t spread, you can try treating the area with an over-the-counter (OTC) antibiotic cream or ointment that contains bacitracin. Then, place a nonstick bandage over the area to help prevent the infection from spreading.

Taking care of your child’s skin can help clear up an impetigo infection faster. Skincare steps you can take to get rid of an impetigo infection quickly include:

• Dab the infected skin with warm soapy water to gently remove crusts.
• Apply the prescribed antibiotic the way your provider suggested.
• Place a bandage over the infected area. This will help promote healing and prevent the infection from spreading.

Will impetigo go away on its own?

Impetigo may go away on its own in a few weeks. Still, healthcare providers recommend treating it for several reasons:

• You reduce your risk of developing complications.
• You reduce your risk of spreading the infection to others.
• Without treatment, the infection can go deeper into your skin and possibly cause new sores or blisters to develop.

Can I prevent impetigo?

The best ways to prevent infections include:

• Keep your hands clean: Wash your hands regularly. Use an alcohol-based sanitizer if you don’t have soap and water.
• Practice good hygiene: Clip your (and your child’s) fingernails regularly to avoid scratching. Sneeze into a tissue and/or your elbow and then throw the tissue away. Bathe daily (or as often as possible), especially if you or your child has eczema or sensitive skin.
• Avoid scratching: Don’t scratch cuts or wounds. If your child gets a cut, scratch or wound, keep them from scratching it.
• Clean wounds: Clean cuts, scrapes and injuries with soap and water. Then put an antibiotic cream or ointment on the wound.
• Keep linens clean: Wash underwear, towels and sheets in hot water.

What’s the outlook for someone who gets impetigo?

Antibiotics can treat impetigo, but the condition can return, especially in young children. Children are especially prone to scratching and opening their scabs, putting them at a higher risk of re-infection. However, most kids recover with no complications after they receive treatment.

How long does impetigo last?

With treatment, your child usually isn’t contagious after 48 hours. The sores may take some time to heal completely, but the infection rarely leaves scars.

Without treatment, impetigo may clear up on its own in a few weeks. But there’s a greater risk of developing complications and you may see new sores and blisters.

How long does impetigo live on surfaces?

The bacteria that cause impetigo can live on dry surfaces for weeks or even months.

When can I go back to work/school?

Impetigo is very contagious. Your child should stay home from school for 48 hours after starting an antibiotic. Adults don’t need to stay home from work, but they should avoid contact with other people and keep their sores and blisters covered.

How can I take care of myself if I have impetigo?

If your healthcare provider diagnosed you or your child with impetigo, these treatment tips can help:

• Keep sores covered: Bandage sores or wear long sleeves and pants.
• Take all medication: Use your antibiotics for the full length of time your provider prescribed them to prevent re-infection.
• Stay clean: Wash the skin gently a few times a day using antibacterial soap. This will remove crusts and drainage.
• Avoid touching the rash: If you do touch it, wash your hands and the exposed area with soap and water.
• Isolate children: If your child has impetigo, keep them away from other children for at least the first 48 hours of treatment. They shouldn’t go to school or daycare.
• Avoid hot tubs and swimming pools: The rash can spread if others come into contact with your child’s skin, swimsuit or towel.

A note from Cleveland Clinic

Impetigo is a common skin condition that usually affects young children. Impetigo is very contagious, so keep your child home until they’ve had at least two days of antibiotics. The medicine will clear up the rash. To prevent impetigo, practice good hygiene. Clean and cover any cuts or scratches to keep them from getting infected.