Impetigo (School Sores)

Impetigo is a contagious bacterial skin infection, most commonly affecting young children in the UK, especially those with eczema. It is caused by Staphylococcus or Streptococcus bacteria.

Symptoms

Impetigo remains contagious until affected areas have healed or at least 48 hours after starting antibiotic treatment. It usually begins with a small, itchy red spot around the mouth, nostrils or behind the ear, but may also appear on the fingers, hands or upper body. Bullous impetigo may present with larger fluid-filled blisters, particularly in children with eczema.

Impetigo usually breaks out in connection with a cold, but impetigo can also occur without the cold. The bacteria can more easily remain in skin that is irritated or damp. The spot develops into a blister, followed by formation of more blisters and red spots. These often leak water or pus before they eventually break and become exuding wounds.

Occasionally, impetigo may cause red, sore patches around the genital area, especially in young children.

What can I do?

To prevent the spread of impetigo, maintain good hygiene practices: wash hands regularly, avoid sharing towels, flannels or bedding, and change clothes and pillowcases daily. Use a clean cloth each time to dry the area. Children should be kept off school or nursery until lesions are healed or for 48 hours after starting antibiotics.

Try to limit the contagion by washing the child’s and your own hands often with soap and water. You should avoid direct contact with the rash, but if you get in contact with the rash, wash hands thoroughly. Good hygiene is essential, and be sure to change towels after contact. Both adults and children should use disposable paper towels. Change clothes and pillow cases every day, and then wash them in hot water (at least 140 degrees). You should try to get the child to avoid scratching or touching the wounds.

Cut the child’s nails short to reduce scratching and clean toys regularly. Disinfect frequently touched surfaces like doorknobs.

If the child has a fever and the affected area is well defined on the skin, you can try treating it yourself. Wash the affected area thoroughly with liquid soap and water both in the morning and the evening. You can also wash it with chlorhexidine, which can be purchased in most pharmacies. Make sure to pat dry with a disposable towel. Even if it might hurt to apply chlorhexidine, it can soak up and remove the scabs formed on the blisters while washing. It is also easier to remove the crusts if you put a wet towel and compress on the wounds for a while before washing. In the beginning, the scabs might come back soon, but by repeating the treatment, the bacteria will stop growing, so wounds usually dries out afterwards.

Should I seek medical care?

Seek medical advice if impetigo is widespread, not improving with self-care, or causing fever. School nurses, GPs, or pharmacists can assess and recommend treatment. In recurrent cases, a swab may be taken to guide antibiotic use.

Treatment

Antiseptic creams such as hydrogen peroxide 1% may be used if the affected area is small. For more extensive impetigo, topical antibiotics like fusidic acid or mupirocin may be prescribed. Oral antibiotics such as flucloxacillin may be needed for widespread infection or systemic symptoms. Treatment is usually 5 to 7 days.

Swabs are usually taken only if initial treatment fails or in recurrent infections, to check for antibiotic resistance.