Impetigo
Also called: school sores, impetigo contagiosa, bullous impetigo, pyoderma
Impetigo is a common, very catching skin infection caused by bacteria. It causes sores that burst and leave golden or honey-coloured crusts, often around the nose and mouth. It is usually mild and clears with an antiseptic cream, an antibiotic cream or antibiotic tablets.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Impetigo is an infection of the top layer of the skin. It is caused by bacteria (germs), mainly Staphylococcus aureus (staph), and sometimes group A Streptococcus (strep), or both. The germs usually get in through skin that is already broken, such as a cut, scratch, insect bite or an itchy rash like eczema or scabies.
Anyone can get impetigo, but it is most common in young children, especially those aged 2 to 5. It spreads easily by touching the sores, and by sharing towels, bedding or toys. It is more common in hot, humid weather and in crowded places such as schools and day-care centres.
There are two main types. Non-bullous impetigo is the most common: small sores or blisters burst and leave golden-brown crusts. Bullous impetigo causes larger, fluid-filled blisters (bullae) and is seen most often in babies and young children.
Impetigo is usually not serious. Without treatment it often heals by itself within 1 to 3 weeks, but treatment helps it heal faster and stops it spreading to other people. Most sores heal without leaving scars.
In Pakistan
In a year-long study of 1,733 new patients at a skin clinic of a private hospital in Karachi, bacterial skin infections (pyodermas) made up about 10 in 100 cases, and impetigo alone about 3 in 100.
Symptoms
- Red sores or small blisters, often around the nose and mouth, or on the hands, arms or legs
- Sores that burst and leak clear fluid or pus
- Thick, sticky crusts that are golden or honey-coloured
- Itching or soreness of the patches, which can spread to nearby skin
- In bullous impetigo, larger blisters filled with yellow fluid that burst and leave a thin yellow-brown crust, often on the body, armpits or nappy area
- Redness that can be harder to see on brown or black skin
- Fever and feeling unwell, which is more common with bullous impetigo
- Swollen glands near the sores
Causes and risk factors
Causes
- Infection with Staphylococcus aureus (staph) bacteria, the most common cause
- Infection with group A Streptococcus (strep) bacteria, alone or together with staph
- Germs getting into skin that is already damaged, such as cuts, scratches, insect bites, burns or itchy rashes
- Spread by skin-to-skin contact or by touching towels, bedding, clothes or toys used by someone with impetigo
- Spread to other parts of your own body by scratching the sores
What makes it more likely
- Being a young child, especially aged 2 to 5
- Close contact with someone who has impetigo, for example in the same house
- Skin conditions that break the skin, such as eczema, scabies, chickenpox or head lice
- Hot, humid weather and summer months
- Crowded places such as schools, nurseries, hostels and prisons
- Poor hygiene, such as not washing hands, face and body regularly
- Diabetes, a weak immune system or poor nutrition
Complications
Most people get better without problems. Scratching can spread the infection to other parts of the body, and picking the sores can sometimes leave scars or patches of lighter or darker skin. The infection can go deeper and cause cellulitis (a more serious infection of the deeper skin). Babies and people with a weak immune system are more likely to have serious problems. Rarely, when strep is the cause, the kidneys can become inflamed (post-streptococcal glomerulonephritis) a week or more after the skin has healed; this can cause swelling, blood in the urine and high blood pressure. Very rarely, strep impetigo can lead to rheumatic fever, and staph toxins can cause a widespread blistering skin illness.
When to see a doctor
- Spreading redness, warmth, swelling or pain around the sores, which may mean cellulitis: see a doctor the same day
- High fever or feeling very unwell, which can mean a more serious infection: get urgent medical help
- Impetigo in a baby aged 11 months or younger, or bullous impetigo in a young baby
- Impetigo in someone with a weak immune system, or impetigo on the breasts while breastfeeding
- Sores that get worse quickly, or do not improve after finishing treatment
- Puffy face or legs, dark or cola-coloured urine or passing less urine in the weeks after impetigo: see a doctor promptly
- Impetigo that keeps coming back
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Diagnosis
A doctor or pharmacist can usually diagnose impetigo just by looking at the sores and the typical golden crusts. Lab tests are not usually needed. They will also check that it is not a more serious skin infection, such as cellulitis, or another condition that can look similar, such as cold sores (herpes simplex), eczema, scabies or chickenpox.
A skin swab (a cotton bud rubbed on a sore and sent to the lab) may be taken if the infection is widespread, keeps coming back, does not get better with antibiotic tablets, or if resistant germs such as MRSA are suspected. If impetigo keeps returning, the doctor may also swab inside the nose, because the germs can live there without causing symptoms. A urine or blood test may be done if kidney problems are suspected after strep impetigo.
Treatment
- Keep the sores clean: gently wash them with soap and water and pat dry, keep them covered, and follow hygiene steps to stop spread
- For a small patch of non-bullous impetigo in someone who is otherwise well, a doctor or pharmacist may suggest hydrogen peroxide cream (an antiseptic) first
- If an antiseptic cream is not suitable, for example near the eyes, or it does not work, a short course of an antibiotic cream is used
- For widespread impetigo, either an antibiotic cream or antibiotic tablets may be used; your doctor decides which suits you best
- For bullous impetigo, or if you are unwell or at high risk of complications, antibiotic tablets are usually needed
- Antibiotic cream and antibiotic tablets are not used together for impetigo. Finish the full course even if the skin looks better
- Go back to your doctor if it gets worse or is not better after treatment. A swab may be taken and the medicine changed; babies with bullous impetigo, very unwell people and people with a weak immune system may need a specialist or hospital
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Topical antibiotics (antibiotic creams and ointments) | For localised impetigo when an antiseptic cream is not suitable or has not worked, and an option for widespread impetigo in someone who is otherwise well. Fusidic acid is usually the first choice cream; mupirocin is used if the germ may be resistant to fusidic acid. Used for a short course only, as germs quickly become resistant | Mupirocin (35 brands) |
| Penicillin-type antibiotics (tablets or syrup) | First choice tablets for widespread or bullous impetigo, or if you are unwell; flucloxacillin is the usual choice in UK guidance. Some guidelines also use amoxicillin with clavulanic acid. Your doctor decides the dose | Amoxicillin + clavulanic acid (176 brands) |
| Macrolide antibiotics (tablets or syrup) | Used instead of a penicillin if you are allergic to penicillin. Erythromycin is the preferred macrolide in pregnancy if one is needed; clarithromycin is used outside pregnancy | Clarithromycin (489 brands), Erythromycin (11 brands) |
| Cephalosporin antibiotics (tablets or syrup) | Another first-line tablet option in some guidelines, such as cephalexin; your doctor decides | Cephalexin (173 brands) |
| Other antibiotics for allergy or resistant germs (MRSA) | Doxycycline may be used for adults with penicillin allergy. Clindamycin or doxycycline may be chosen if MRSA (a resistant staph germ) is found or is common locally. Your doctor may ask a microbiology specialist for advice | Doxycycline (80 brands), Clindamycin (42 brands) |
Also used (not yet in our price list): Hydrogen peroxide cream (an antiseptic cream; first choice for small patches in UK guidance), Fusidic acid cream on its own (first-choice antibiotic cream in UK guidance), Flucloxacillin (first-choice antibiotic tablet or syrup in UK guidance), Retapamulin ointment (an antibiotic ointment used in some countries), Antiseptic body wash and antibiotic nasal ointment to clear germs from the skin and nose (decolonisation) when impetigo keeps coming back
Self-care and prevention
Self-care
- Gently wash the sores with soap and water and dry them well; wash off loose crusts before putting on cream
- Cover the sores with a loose dressing or clothing where you can
- Wash your hands often, especially before and after touching the sores or putting on cream
- Do not touch, scratch or pick the sores
- Do not share towels, face cloths, bedding or clothes; wash them, and children's toys, often, using hot water for bedding
- Do not prepare food for other people, and avoid the gym and contact sports such as football until you are no longer infectious
- Use the full course of treatment, even if the skin starts to clear
Prevention
- Keep cuts, scratches and insect bites clean by washing them with soap and water
- Get treatment for itchy skin conditions such as eczema, scabies and head lice, which make impetigo more likely
- Wash hands, face and body regularly, especially in hot weather
- Do not share towels, clothes or bedding, and wash them often if someone at home has impetigo
- Keep children with impetigo away from school or nursery until they are no longer infectious
Common questions
Is impetigo contagious?
Yes, it spreads very easily by touching the sores or things like towels and bedding. Treatment quickly makes it much less catching. Without treatment it stays catching until the sores have dried and crusted over.
When can my child go back to school?
This depends on local advice. In the UK, the NHS advises staying off school, nursery or work until 48 hours after starting treatment, or until the sores have crusted over if not treated. The US CDC says children can go back once they have started antibiotics and all sores on uncovered skin are covered. Ask your doctor if you are not sure.
Will impetigo leave a scar?
Usually not, because the infection is only in the top layer of skin. Scratching or picking the sores can sometimes cause scars or patches of lighter or darker skin, which often fade over time.
Why should I not keep using an antibiotic cream?
Germs can become resistant to antibiotic creams quickly, especially if they are used for a long time or again and again. This makes them stop working. Use the cream only for the short course your doctor or pharmacist advises, and see a doctor if impetigo keeps coming back.
Is impetigo treatment safe in pregnancy?
Many treatments can be used, but the choice needs care. UK guidance names erythromycin as the preferred macrolide antibiotic in pregnancy if a person cannot take a penicillin. If you are pregnant or breastfeeding, let your doctor or midwife choose the treatment.
Sources
- NICE. Recommendations - Impetigo: antimicrobial prescribing (NICE guideline NG153) (n.d.).
- CDC. Clinical Guidance for Group A Streptococcal Impetigo (n.d.).
- CDC. About Impetigo (n.d.).
- NHS Forth Valley (antimicrobial prescribing guidance). Impetigo | Right Decisions (n.d.).
- NHS 111 Wales. NHS 111 Wales - Health A-Z : Impetigo (n.d.).
- StatPearls (NCBI Bookshelf). Impetigo - StatPearls - NCBI Bookshelf (n.d.).
- Journal of Pakistan Association of Dermatologists (Maryum, Alam, Ahmed). Pattern of skin diseases in a tertiary care private hospital, Karachi (2014).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.