Impetigo

Impetigo is a common skin infection that spreads very easily. It causes sores and blisters. It's not usually serious, and it often gets better within a week of treatment, or within a few weeks if you don't treat it.

In the UK, impetigo is the most common skin infection in young children, but people of all ages can get it.

Impetigo comes in 2 types:

• non-bullous impetigo, which is the most common type
• bullous impetigo

Non-bullous impetigo starts with red sores. They usually appear around the nose and mouth, but other parts of the face and the limbs can be affected too.

The sores burst quickly and leave thick, golden crusts, typically around 2cm across. Some people say these crusts look like cornflakes stuck to the skin.

Once the crusts dry, they leave a red mark that usually fades without scarring. How long the redness takes to go can vary from a few days to a few weeks.

The sores aren't painful, but they may itch. Try not to touch or scratch them, because this can spread the infection to other parts of your body and to other people.

Other symptoms, such as a high temperature (fever) and swollen glands, are rare. They can occur in more severe cases.

Bullous impetigo starts with fluid-filled blisters (bullae). They usually show up on the central part of the body between the waist and neck, or on the arms and legs. Each blister is usually about 1cm to 2cm across.

The blisters can spread quickly. After several days they burst and leave a yellow crust, which usually heals without scarring.

They may be painful, and the skin around them may itch. As with non-bullous impetigo, don't touch or scratch the affected areas.

Fever and swollen glands are more common with bullous impetigo.

Impetigo isn't usually serious, and a pharmacist can treat it. If needed, your pharmacist may suggest that you see a doctor.

Adults and children over 2 years who have impetigo can go straight to a pharmacy for advice and treatment.

Impetigo happens when bacteria infect the skin. The bacteria are usually either Staphylococcus aureus or Streptococcus pyogenes.

They can get into the skin in 2 main ways:

• through a break in otherwise healthy skin, such as a cut, insect bite or other injury. This is known as primary impetigo
• through skin already damaged by another skin condition, such as head lice, scabies or eczema. This is known as secondary impetigo

The bacteria spread easily through close contact with someone who has the infection. That can be direct physical contact, or sharing towels or flannels.

Impetigo doesn't cause any symptoms until 4 to 10 days after the first exposure to the bacteria, so people often pass it on to others without meaning to.

Children are most at risk of getting impetigo, and so are people with diabetes or a weakened immune system. The weakened immune system may come from a condition such as HIV or from a treatment such as chemotherapy.

Impetigo usually gets better on its own in around 2 to 3 weeks. Still, treatment is often recommended, because it can cut the illness down to around seven to 10 days and can lower the risk of passing the infection on to others.

The main treatments a doctor prescribes are antibiotic creams or antibiotic tablets. You usually have to use these for around a week.

While you're being treated for impetigo, take some care so the infection doesn't spread to other people or to other parts of your own body.

Most people are no longer contagious after 48 hours of treatment, or once their sores have dried and healed. Stay away from work, school, nursery or playgroup until then.

These steps can also help stop the infection spreading:

• Don't share face cloths, sheets or towels with anyone who has impetigo, and wash them at a high temperature after use.
• Wash the sores with soap and water, then cover them loosely with a gauze bandage or clothing.
• Avoid touching or scratching the sores, and don't let others touch them. Keeping your nails clean and short may help.
• Avoid contact with newborn babies, preparing food, playing contact sports and going to the gym until the risk of infection has passed.
• Wash your hands often, especially after touching infected skin.
• Wash any washable toys. For soft toys that can't be washed, wipe them thoroughly with a cloth wrung out in detergent and warm water, then let them dry completely.

If you think the infection has spread to someone else, get them seen by a pharmacist as soon as possible.

To lower the chance of impetigo coming back, keep any cuts, scratches or bites clean. If you have a condition that breaks the skin, such as eczema, get it treated promptly.

If you get impetigo often, your doctor may suggest taking a swab from around your nose. This checks whether you carry staphylococcal bacteria. In some people these bacteria live in the nose and cause no problems, but they can lead to impetigo if they infect broken skin nearby.

If you do carry these bacteria, you may be prescribed an antiseptic nasal cream. You apply it several times a day for 5 to 10 days, to try to clear the bacteria and reduce the chances of impetigo recurring.

Complications from impetigo are rare, but when they do happen they can be serious. If you have impetigo and your symptoms change or get worse, tell your pharmacist.

Some of the complications linked to impetigo are:

• cellulitis, an infection of the deeper layers of the skin and the tissue underneath
• scarlet fever, a rare bacterial infection that causes a fine, pink rash across the body
• guttate psoriasis, a skin condition that is not an infection and can develop in children and teenagers after a bacterial infection
• septicaemia (a type of sepsis), a bacterial infection of the blood
• Staphylococcal scalded skin syndrome (SSSS), a serious skin condition in which the skin looks as if it has been scalded with boiling water
• post-streptococcal glomerulonephritis, an infection of the small blood vessels in the kidneys

In very rare cases, impetigo may leave some scarring, especially if you scratch at the blisters, crusts or sores.

Impetigo doesn't cause any symptoms until 4 to 10 days after you first become infected. So people can easily pass the infection on to others without realising it.

There are 2 main types of impetigo, called non-bullous and bullous impetigo, and their symptoms are different. Most people with impetigo have the non-bullous type.

Non-bullous impetigo starts with red sores. They usually appear around the nose and mouth, but other parts of the face and the limbs can be affected too.

The sores burst quickly and leave thick, golden crusts, typically around 2cm across. Some people say these crusts look like cornflakes stuck to the skin.

Once the crusts dry, they leave a red mark that usually heals without scarring. The redness can take anything from a few days to a few weeks to go.

The sores aren't painful, but they may itch. Try not to touch or scratch them, because that can spread the infection to other parts of your body and to other people.

Other symptoms, such as a high temperature (fever) and swollen glands, are rare but can occur in more severe cases.

Bullous impetigo starts with fluid-filled blisters (bullae). They usually appear on the trunk (the central part of the body between the waist and neck), or on the arms and legs. Each blister is usually about 1cm to 2cm across.

The blisters can spread quickly. After several days they burst and leave a yellow crust, which usually heals without scarring.

The blisters may be painful, and the skin around them may be itchy. As with non-bullous impetigo, you should not touch or scratch the affected skin.

Fever and swollen glands are more common in bullous impetigo.

Impetigo happens when the skin becomes infected with bacteria, usually either Staphylococcus aureus or Streptococcus pyogenes.

These bacteria can get into the skin in 2 ways:

• through a break in otherwise healthy skin, such as a cut, insect bite or other injury (this is known as primary impetigo)
• through skin damaged by another underlying skin condition, such as head lice, scabies or eczema (this is known as secondary impetigo)

The bacteria spread easily through close contact with someone who has the infection. That can be direct physical contact, or sharing towels or flannels.

Impetigo doesn't cause any symptoms until 4 to 10 days after the first exposure to the bacteria, so people often pass it on to others without meaning to.

It stops being infectious 48 hours after treatment starts, or once the sores have stopped blistering or crusting.

Several other things can raise your chances of getting impetigo. These include:

• being a child, because impetigo is thought to be more common in children. Their immune system has not yet fully developed, and they tend to spend time in places where the infection can easily be spread, such as schools and nurseries
• having diabetes
• being a carrier of Staphylococcus aureus bacteria. These bacteria can live in the noses of some people without causing problems, but they can sometimes cause impetigo if they get into damaged skin nearby
• warm and humid weather. Impetigo tends to be more common during the summer months in the UK, possibly because the warm and moist weather is a better environment for the bacteria to grow and/or because the skin is more likely to be exposed to insect bites and cuts at this time of year
• having a weakened immune system, either due to a condition such as HIV or a treatment such as chemotherapy

Impetigo isn't usually serious, and it often clears up on its own after 2 to 3 weeks.

Even so, treatment is often recommended. It can help clear the infection in around 7 to 10 days, and it lowers the risk of passing impetigo on to other people.

Once the diagnosis is confirmed, antibiotics can usually treat it well.

If an underlying skin condition, such as eczema, is causing the infection, that may need treatment too.

If your impetigo is mild and covers only a small area of skin, a doctor will often recommend an antibiotic cream. You usually apply it 3 or 4 times a day for 7 days.

Before you put the cream on, wash the affected skin with warm, soapy water and try to clean off any crusts that have formed.

The infection can spread, so wash your hands straight after applying the cream. If you have latex gloves, wear them while you apply it.

Side effects of the cream can include:

• irritation
• redness
• itchiness in the area where the cream is applied

If your symptoms haven't improved seven days after you start treatment, ask your pharmacist about other treatment options.

Your doctor may prescribe antibiotic tablets if the impetigo is more severe and widespread, or if the symptoms don't improve after you've used antibiotic cream. You'll usually need to take them 2 to 4 times a day for 7 days.

If antibiotic tablets are prescribed for you or your child, it's very important to finish the whole course, even if the symptoms clear up before you've taken all the tablets.

Common side effects of oral antibiotics include:

• feeling sick
• vomiting
• diarrhoea

If your symptoms haven't improved after 7 days of treatment with antibiotic tablets, speak to your pharmacist.

Most people with impetigo don't need further tests. They're usually only needed if the infection is severe or widespread, doesn't respond to treatment, or keeps coming back.

In these cases, your doctor may refer you to a dermatologist (skin specialist) for more tests, or they may take a swab of the affected skin themselves and send it for testing. A swab can help rule out or confirm other skin conditions that might be causing your symptoms. It can also show whether you carry, inside your nose, one of the types of bacteria responsible for the infection.

If your doctor thinks you keep getting impetigo because these bacteria naturally live inside your nose, they may prescribe an antiseptic nasal cream to try to clear them.

Serious problems from impetigo are rare, but they can happen. If you have impetigo and your symptoms change or get worse, tell your pharmacist.

Cellulitis happens when the infection spreads into a deeper layer of skin. The skin turns red and inflamed, and you may also have a fever and pain. Doctors can usually treat cellulitis with antibiotics, and you can take painkillers to ease the pain.

Guttate psoriasis is a skin condition that isn't infectious, so you can't catch it from someone else. It can develop in children and teenagers after a bacterial infection. It's more common after a throat infection, though some cases have been linked to impetigo.

The condition causes small, red, scaly patches shaped like droplets. They appear on the chest, arms, legs and scalp.

Creams can be used to control the symptoms. In some cases, guttate psoriasis disappears completely after a few weeks.

Scarlet fever is a rare bacterial infection that causes a fine, pink rash across the body. Symptoms such as nausea, pain and vomiting are also common. Doctors usually treat the condition with antibiotics.

Scarlet fever is not usually serious, but it is contagious. So you should keep an infected child apart from others and avoid close physical contact. Keep your child away from school and other people until they have been taking antibiotics for at least 24 hours.

Septicaemia is a bacterial infection of the blood, and it is a type of sepsis. It can cause:

• diarrhoea
• cold, clammy skin
• a high temperature (fever)
• rapid breathing
• vomiting
• low blood pressure (hypotension)
• confusion
• feeling faint and dizzy
• losing consciousness

Septicaemia is life-threatening. You need treatment straight away, with antibiotics in hospital.

Impetigo may lead to some scarring in rare cases. More often, though, a scar comes from scratching at the blisters, crusts or sores. If you leave them alone to heal, the blisters and crusts themselves shouldn't leave a scar.

The red mark that stays after the crusts and blisters clear up should also fade by itself. How long that takes varies, anywhere from a few days to a few weeks.

Staphylococcal scalded skin syndrome (SSSS) is a serious skin condition. It happens when Staphylococcus bacteria, one of the causes of impetigo, release a toxin (poison) that damages the skin.

The damage leads to widespread blistering, and the skin looks as if it has been scalded with boiling water.

Other symptoms of SSSS include:

• painful skin
• a high temperature (fever)
• large areas of skin peeling off or falling away
• redness of the skin, which usually spreads across the entire body

SSSS usually needs immediate treatment in hospital, with antibiotics given directly into a vein (intravenously).

Post-streptococcal glomerulonephritis is an infection of the small blood vessels in the kidneys. It's a very rare complication of impetigo.

The symptoms of post-streptococcal glomerulonephritis include:

• a change in the colour of your urine to a reddish-brown or cola colour
• swelling of the abdomen (tummy), face, eyes, feet and ankles
• a rise in blood pressure
• visible blood in your urine
• a reduction in the amount of urine you would normally produce

People with this condition will usually need immediate hospital treatment, so their blood pressure can be carefully monitored and controlled.

Post-streptococcal glomerulonephritis can be fatal in adults, although deaths in children are rare.

Impetigo spreads very easily from one person to another, so you need to take some care to lower the chance of passing the infection on.

To help stop impetigo spreading to other people or to other parts of your own body, you should:

• stay away from work, school, nursery or playgroup until the sores have dried up, blistered or crusted over, or until 48 hours after starting treatment
• not share face cloths, sheets or towels with anyone who has impetigo, and wash them at a high temperature after use
• wash the sores with soap and water, and cover them loosely with a gauze bandage or clothing if possible
• avoid touching the sores, or letting others touch them, whenever possible
• not scratch the affected areas. It may help to keep your nails or your child's nails clean and short, which lowers the risk of further damage from scratching
• avoid contact with newborn babies, preparing food, playing contact sports, or going to the gym until the risk of infection has passed (when the rash has crusted over, or after at least 48 hours of treatment with antibiotics)
• wash your hands frequently, particularly after touching infected skin
• wash toys that can be washed, and wipe soft toys that can't be washed thoroughly with a cloth wrung out in detergent and warm water, then let them dry completely

If you think the infection has spread to someone else, make sure they contact their pharmacist as soon as possible.

To lower the risk of impetigo coming back, keep any cuts, scratches or bites clean. If you have a condition that breaks the skin, such as eczema, get it treated promptly.

If you get impetigo often, your doctor may suggest taking a swab from around your nose. This checks whether you carry staphylococcal bacteria inside your nose. These bacteria can live in some people's noses without causing problems, but they can lead to impetigo if they infect broken skin nearby.

If you do carry these bacteria, you may be prescribed an antiseptic nasal cream. You apply it several times a day for 5 to 10 days, to try to clear the bacteria and reduce the chances of impetigo recurring.