Impetigo is one of the most common bacterial skin infections in children — a condition that spreads quickly through nurseries and households and which parents tend to recognise after the first encounter because of its distinctive appearance. Understanding what impetigo looks like, how to treat it, and the important hygiene and exclusion steps helps families manage it quickly and prevent spread.
Healthbooq supports parents with practical guidance on common childhood skin infections, including the treatment and prevention of impetigo.
What Impetigo Is and What It Looks Like
Impetigo is a superficial bacterial infection of the skin, not involving the deeper layers. The two most common causative bacteria are Staphylococcus aureus and Streptococcus pyogenes (Group A Streptococcus), and many cases involve a mixed infection of both.
There are two main forms. Non-bullous impetigo (the most common form in children) begins as small red sores or blisters, which quickly burst and leave behind the characteristic golden-yellow crusts — sometimes described as honey-coloured or cornflake-like — that are the hallmark of the condition. These crusts typically appear around the nose and mouth but can appear anywhere on the skin, including on the limbs and trunk. They may be mildly itchy.
Bullous impetigo is less common, caused predominantly by S. aureus, and presents as larger, fluid-filled blisters (bullae) that burst and leave a thin, lacquer-like crust. It is more common in neonates and young infants.
Both forms are superficial and, while alarming in appearance, are not usually associated with significant illness. Secondary spread is common — scratching transfers bacteria to other areas of the skin and to other people.
Treatment
NICE guidance recommends topical antibiotic treatment as first-line for non-bullous impetigo affecting a limited area. Hydrogen peroxide cream (1% — available over the counter as Crystacide) is now recommended as the preferred first-line topical treatment by NICE (2020 guidance). Fusidic acid cream (prescription required) is an alternative. The topical treatment is applied three times daily to all affected areas for five days, after gentle removal of crusts with warm water if possible.
Oral antibiotics are used when the infection is extensive, when topical treatment has failed, in immunocompromised children, in neonates, or when there is associated fever or signs of systemic infection. Flucloxacillin is the first-line oral antibiotic for S. aureus impetigo; co-amoxiclav or erythromycin are alternatives.
Exclusion and Hygiene
Children with impetigo should not attend nursery, school, or childcare for forty-eight hours after starting antibiotic treatment (UKHSA guidance). If treatment is not being used, children should be excluded until all sores have crusted over and dried.
To prevent spread within the household: the affected child should not share towels, flannels, or pillowcases; hands should be washed thoroughly after touching the affected areas; infected areas should be kept loosely covered where practical to reduce scratch-and-spread; the child's nails should be kept short; and separate personal washing items should be used.
Impetigo in Children with Eczema
Children with eczema are at increased risk of impetigo because of the disrupted skin barrier and frequent scratching. In eczema, impetigo may appear as a sudden worsening of existing eczema patches with weeping, crusting, and spreading — rather than the classic pattern of impetigo in previously intact skin. If eczema suddenly deteriorates significantly despite usual management, a GP review to consider secondary bacterial infection is warranted.
Key Takeaways
Impetigo is a highly contagious superficial bacterial skin infection most commonly caused by Staphylococcus aureus or Streptococcus pyogenes (Group A Streptococcus). It presents as golden-crusted sores or fluid-filled blisters on the skin, typically on the face (around the nose and mouth), and is very common in young children. It is treated with topical antibiotic cream (fusidic acid or hydrogen peroxide cream for non-bullous impetigo) as first-line, or oral antibiotics for extensive or unresponsive infection. Children should remain off nursery or school for forty-eight hours after starting antibiotic treatment, or until the sores are crusted and dry.
