Impetigo

Impetigo (im-puh-TIE-go) is a highly contagious bacterial skin infection which can affect anyone of any age although it is more common in infants and young children between 2 and 5 years of age. Indeed, it is the most common skin infection in young children in the UK.

Impetigo usually starts by presenting as red sores or blisters on the face, particularly around the nose and mouth. It can also appear on the hands and feet. The red sores may be harder to see on black or brown skin. After a week, the sores typically burst and develop into honey-coloured crusts or patches.

Impetigo can resolve within 7 to 10 days if it is treated with antibiotics.

What are the causes of Impetigo?

Impetigo is caused by two specific bacteria:

• Staphylococcus aureus
• Streptococcus pyogenes

The bacteria infects the skin by two routes:

• Cuts, insect bites or other skin injury (this is known as Primary Impetigo)
• Skin damage caused by eczema, scabies or head lice (this is known as Secondary Impetigo)

The bacteria can easily spread through close contact with someone who already has the infection. This can be through direct physical contact, or by sharing towels or flannels. Symptoms don’t present for at least 4 days and in some cases up to 10 days, therefore it can be easy to unintentionally spread it.

Apart from children who are prone to impetigo, other groups can also be at high risk of developing impetigo:

• Diabetics
• People who are immunocompromised through conditions such as HIV
• People who are immunocompromised through taking medications that reduce their immune system.

What are the symptoms of Impetigo?

The first signs that indicate you may have Impetigo are:

• Red sores (non-bullous impetigo)
• Blisters (bullous impetigo)
• Sores or blisters that burst to form crusty patches

What is Bullous Impetigo?

Bullous impetigo begins with the appearance of fluid-filled blisters (bullae) which usually occur on the torso between the waist and neck, or on the arms and legs. The blisters can typically be 1 cm to 2 cm in dimension.

The blisters can spread quickly before bursting after a few days to leave a yellow crust which usually scabs and heals without leaving any scarring.

The blisters can be painful with the area of skin around them being itchy. Additional symptoms such as high temperature (fever) and swollen glands are also common in bullous impetigo cases.

Bullous Impetigo is less common than Non-Bullous Impetigo.

What is Non-Bullous Impetigo?

Non-bullous impetigo begins with the appearance of red sores. It presents around the nose and mouth although it can also affect other areas of the face and the limbs.

The sores burst relatively quickly and leave behind thick, honey-coloured crusts which are typically 2 cm in dimension. The honey-coloured crusts appear like cornflakes stuck to the skin. Once the crusts dry, they leave behind a red mark which usually fades without scarring. This can take between a few days and a few weeks.

The sores are not painful, although they can be itchy. To avoid spreading the infection, it is advisable not to touch or scratch the sores.

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

When to get advice from a GP

You should contact your GP if you suspect you have Impetigo and you have:

• Had treatment for impetigo but the symptoms changed or got worse
• Had impetigo before and it keeps coming back

Impetigo is very infectious. Check with the GP before you go into the surgery. They may suggest a phone consultation.

Check if you qualify for FREE treatment with NHS Pharmacy First, without seeing your GP

You can check your eligibility to use the NHS Pharmacy First service if you suspect you have Impetigo and you:

• Are 18 years or over
• Have not had Impetigo before

The NHS Pharmacy First service may not be suitable if:

• Serious complications suspected such as deeper soft tissue infection
• There is a risk of deterioration or serious illness
• You are immunocompromised and the infection is widespread

The NHS Pharmacy First service is available to all NowPatient users who are registered with the NHS in England. If you are exempt from paying for your prescriptions, the service and the treatments are provided free of charge. If you are not exempt from paying prescription charges, treatments are provided at the prevailing NHS prescription charge rate. There is no charge for consultations.

What NHS Pharmacy First treatments are available for Impetigo?

Treatment for Impetigo is recommended because it can reduce the length of the illness to around seven to 10 days and can lower the risk of cross-infecting others.

The main treatments prescribed are antibiotic creams or antibiotic tablets. These treatments are usually prescribed for a one-week course.

Individuals with diagnosed impetigo can return to work, school, or daycare if they:

• Have started antibiotic treatment; and
• Keep all sores on exposed skin covered

Do I have an increased risk of Impetigo?

Some people have an elevated risk of getting Impetigo, based on certain factors:

• Infections like Scabies can increase the risk of Impetigo
• Children and Infants between 2 years and 5 years of age
• People who participate in activities where cuts and scrapes are common can increase the risk of Impetigo
• Group contact with people who have Impetigo could increase the risk
• Poor personal hygiene

How can I prevent the spread of Impetigo?

If you have been diagnosed as having Impetigo, you should:

• Wash the sores with soap and water and cover them loosely with a gauze bandage or clothing
• Avoid scratching the sores or touching them
• Avoid contact with newborn babies or other infants until the risk of infection has passed
• Avoid preparing food until the risk of infection has passed
• Avoid playing contact sports until the risk of infection has passed
• Wash your hands frequently
• Not share flannels, sheets or towels with anyone who has impetigo
• Wash flannels, sheets or towels at a high temperature after use

What happens if I do not get treatment for Impetigo?

Impetigo is not usually serious and it will improve within a week of treatment or within 2-3 weeks if you are not treated,

What are the complications of Impetigo?

Although rare, some complications of impetigo can be serious. These include::

• Cellulitis
• Scarlet Fever (rare bacterial infection)
• Guttate Psoriasis (a non-infectious skin condition)
• Septicaemia (sepsis – infection of blood)
• Staphylococcal scalded skin syndrome (SSSS)
• Post-Streptococcal Glomerulonephritis (infection of blood vessels in Kidney)
• Scarring

Sources

• CDC – Impetigo
• NHS Scotland – Impetigo
• NHS – Impetigo condition