Impetigo consultation

Impetigo is a very contagious common skin infection, but it is often not serious. It usually starts with red sores or blisters, which tend to leave crusty patches. These are most commonly found around the nose, mouth, hands, and feet.

While anyone can get impetigo, it affects children more often than adults. It can clear up by itself, but you can get treatment to help it clear up more quickly.

The symptoms of impetigo:

• starts with red sores or blisters (may be harder to see on darker skin tones)
• often starts around the nose, mouth, hands and feet
• sores and blisters burst to leave crusty patches
• crusty patches can get bigger and spread to other areas of your body
• the patches look a bit like cornflakes and can be itchy and painful

A medical review in 2015 estimated that over 1 in 10 children get impetigo during childhood.

Staphylococcus aureus bacteria usually cause impetigo. Bacteria can enter the skin through a break in otherwise healthy skin (e.g. a bite, injury or cut) or where there is an underlying skin condition such as eczema or scabies.

There are two different types of impetigo:

Nonbullous

• this is the most common form of impetigo
• starts with itchy red sores around the mouth and nose, which break open to form a yellow crust

Bullous

• starts with blisters which have liquid inside. The liquid is usually clear but can be darker
• a yellow crust forms once the blisters burst
• it can be associated with other symptoms, such as fever, nausea and diarrhoea

Treatment for impetigo is usually antibiotics that work by stopping the bacterial infection that is causing it. Antibiotics are usually creams applied on the skin (topical) or pills taken by mouth (oral).

Your doctor may recommend an antiseptic cream such as hydrogen peroxide 1%. Antiseptics also work to stop the bacteria from spreading.

Once treatment has started, impetigo usually clears up in a week or 10 days. If it takes longer to clear up or is getting worse despite treatment, talk to your doctor. There may be an underlying skin condition that needs treating.

Impetigo can clear up on its own, but the right treatment can help relieve the infection quickly. As impetigo is very contagious, it is essential to treat it quickly to avoid it spreading.

Can impetigo come back after treatment?

Impetigo can come back again after treatment. It is essential to complete the course of treatment to prevent an immediate recurrence.

The sores you get with impetigo are very contagious. You can help prevent the spread by:

• practising good hygiene such as regular careful handwashing
• washing or cleaning any items that come into contact with the sores
• not sharing personal items with someone who has impetigo

Prescribed treatment for impetigo is usually a topical antiseptic cream or antibiotic cream applied to the skin, or an oral antibiotic tablet taken orally. These treatments are effective at clearing up impetigo if used correctly.

Topical antibiotic cream

• treats impetigo that covers a relatively small and contained area
• doctors usually prescribe Fusidic acid 2%
• you typically apply it 3 to 5 times daily for 5 to 7 days
• brand name is Fucidin

Oral antibiotics

• treats impetigo that covers a broader area or is more severe
• doctors usually prescribe flucloxacillin or clarithromycin
• you usually take it 4 times daily for 5 to 7 days
• the usual dose is 250mg or 500mg
• brand names for flucloxacillin include Floxapen and Co-fluampicil
• brand names for clarithromycin are Klaricid, Klaricid XL, Xetinin XL

There is no ‘best’ treatment for impetigo. The right treatment depends on how extensive the impetigo is and whether you have any underlying health conditions. If impetigo does not clear up with initial treatment, your doctor may investigate underlying causes.

The side effects of impetigo treatment vary depending on your treatment. If you get side effects, they often stop within a few days of starting the medication. If you find them impacting your life, talk to your doctor.

Topical antibiotics

The side effects of topical antibiotics usually relate to the skin that is being treated. It can feel red, swollen and itchy.

Oral antibiotics

Common side effects from flucloxacillin and clarithromycin include:

• feeling and being sick
• diarrhoea
• indigestion and bloating
• headaches
• difficulty sleeping

Allergic reaction

One serious side effect can be a severe allergic reaction. If you have any of the following symptoms, call 999 and get urgent medical attention:

• trouble breathing and talking
• wheezing and tightness in your chest
• swelling on your mouth, face, lips, throat or tongue
• itchy, red, swollen, peeling or blistered skin

Most people can use a topical antibiotic for impetigo unless they are allergic to the active ingredient.

Some people cannot take oral antibiotics to treat impetigo. Some antibiotics may not be safe to take if you have specific medical conditions or are pregnant or breastfeeding. You may also need to take care when taking certain antibiotics alongside certain foods, alcohol or the contraceptive pill. The patient information leaflet that comes with your medicine has guidance.

Always tell your doctor about any medicines you take and your health conditions. They can ensure that the treatment they prescribe you is safe to take.

To find out if you need impetigo treatment, you need to see a doctor or nurse who will diagnose you. Impetigo is diagnosed by looking at the rash. The rash can look similar to other skin conditions, which is why a doctor needs to diagnose you.

If impetigo keeps coming back, the doctor may take a swab from your nose to test which bacteria are causing the infection.

You can get an online diagnosis and prescription from our doctors using our skin diagnosis service:

1. take photos of the infected area following our instructions
2. upload the images to your patient account
3. our doctors will review the photos in one working day and issue you with a prescription for treatment

Other treatment options for impetigo include home remedies such as:

• essential oils like geranium oil, patchouli oil and tea tree oil
• manuka honey

However, there needs to be more scientific evidence to prove whether these work. There is no guarantee that these home remedies will stop an outbreak of impetigo.

Yes. Treatment is effective at curing an outbreak, but you may get impetigo again in the future.