Impetigo in Children: Symptoms, Treatment, and Contagion

Your child has developed some small sores around the nose that don't look quite right. They have yellowish crusts, and they seem to be spreading. Could it be impetigo?

Impetigo is one of the most common skin infections in children, and most parents encounter it at least once. It can look unpleasant, but it is rarely serious. With the right treatment and good hygiene, most children recover within about a week.

Here is everything you need to know about impetigo — from symptoms and contagion to treatment and when to keep your child home.

What Is Impetigo?

Impetigo is a superficial bacterial skin infection that affects the outermost layer of skin. The infection is caused by bacteria — either Staphylococcus aureus, Group A Streptococcus, or both together.

The condition is highly contagious and most commonly affects children between 2 and 6 years old, but infants and older children can also get it. Impetigo often develops where the skin is already damaged, such as around cuts, insect bites, eczema, or nasal sores from a cold.

There are two main types:

• Non-bullous impetigo — the most common form, with small blisters that quickly break open and form honey-colored crusts
• Bullous impetigo — with larger, fluid-filled blisters (0.5–3 cm), caused by toxin-producing staphylococci. This type is more common in infants

What Impetigo Looks Like — Symptoms

Symptoms vary slightly depending on type, but there are some typical signs parents should look for.

Non-Bullous Impetigo (Most Common)

• Starts with small red spots or blisters
• Blisters break quickly and form thick, honey-colored or golden crusts
• Red, irritated skin around the crusts
• May itch, but is usually not painful
• Sores may ooze amber-colored fluid when crusts are removed

Bullous Impetigo

• Larger, flaccid blisters (0.5–3 cm) with clear or cloudy fluid
• Blisters sit on apparently healthy skin with a thin red rim
• When blisters burst, thin, light-brown crusts form on moist, red wound surfaces
• Can cause somewhat more discomfort than the non-bullous form

Where on the Body?

Impetigo most often appears on exposed skin — especially on the face around the nose and mouth, but also on the hands, arms, and legs. In children who wear diapers, impetigo can also appear in the diaper area.

How Does Impetigo Spread?

Impetigo is highly contagious and spreads in two ways:

• Direct contact — person to person via touching sores or wound fluid
• Indirect contact — via objects such as towels, cloths, toys, or bedding that have been in contact with wound fluid

The incubation period is usually 4–10 days from exposure to symptoms.

The child is contagious as long as there are open, weeping sores. Contagion risk decreases significantly when the sores are dry, covered, or well on their way to healing.

Treatment of Impetigo

Treatment depends on how widespread the infection is. The AAP and international dermatology guidelines distinguish between three levels.

1. Mild Infection — Antiseptic Washing (First Choice)

For a few, small sores limited to one area, antiseptic local treatment is sufficient:

• Wash the sores 2–3 times daily with soap and lukewarm water
• Remove crusts gently (soften first with a damp cloth)
• Chlorhexidine can be used for antiseptic washing
• Cover the sores with dry compresses or plasters

Antiseptic washing is recommended over antibiotic cream for mild infections to avoid unnecessary antibiotic use and resistance development.

2. Moderate Infection — Antibiotic Cream

For multiple sores in one area, or if antiseptic washing hasn't worked after a few days, your doctor may prescribe topical antibiotics:

• Mupirocin (Bactroban) — antibiotic cream applied 2–3 times daily
• Retapamulin (Altabax) — alternative antibiotic cream
• Fusidic acid cream — available in some countries

Treatment usually lasts 5–7 days. Continue antiseptic washing in addition.

3. Widespread Infection — Oral Antibiotics

Systemic antibiotics (tablets or liquid) are used when:

• The infection is widespread across multiple body areas
• Bullous impetigo in infants
• Poor general condition or fever
• No response to topical treatment

Common antibiotics include cephalexin or dicloxacillin (in liquid form for children). The doctor determines the type and dose based on the child's age, weight, and severity of infection.

Impetigo and Daycare — When Can the Child Return?

This is perhaps the most common question from parents. The AAP and the CDC's Advisory Committee on Immunization Practices (ACIP) provide the following guidance:

The child can return to daycare when the sores are under control:

• With few and small sores: The sores can be well covered with a plaster or gauze, so other children cannot come into contact with the wound fluid
• With widespread infection: The sores must be dry and well on their way to healing

There is no fixed time limit — the assessment is based on clinical judgment from the doctor or parents. The main rule is that there should be no risk of spreading infection through fluid from the sores, either directly or indirectly.

Prevention of Impetigo

Good hygiene is the most important measure for preventing impetigo and stopping it from spreading:

• Handwashing — wash hands thoroughly with soap and lukewarm water, especially after touching the sores
• Own towels — the child with impetigo should have their own towels, washcloths, and bedding
• Keep wounds clean — cuts, insect bites, and other minor wounds should be washed and covered
• Don't scratch — keep the child's nails clipped short to reduce the risk of spreading through scratching
• Wash toys — in daycare settings, shared toys should be washed regularly
• Bedding and towels — wash at a high temperature (140°F / 60°C or above)

Children with eczema or atopic dermatitis are more susceptible to impetigo because the skin barrier is weakened. Good skincare and treatment of eczema is important prevention.

When Should You Contact a Doctor?

Most cases of impetigo can be managed at home with good hygiene and antibiotic cream from the doctor. But contact your doctor if:

• The child is under 1 year — infants with impetigo, especially bullous form, should always be evaluated by a doctor
• The sores are spreading — despite treatment for 2–3 days
• The child develops a fever — may indicate the infection has spread deeper
• Poor general condition — the child is unusually lethargic, irritable, or won't eat
• The area around the sores becomes swollen, red, and warm — may indicate cellulitis (deeper skin infection)
• Dark or reddish urine — rare, but can be a sign of kidney-related complications

Is Impetigo Dangerous? Possible Complications

Impetigo is usually a harmless, self-limiting infection that heals without scarring. Most children recover completely within 7–10 days with proper treatment.

In rare cases, complications can occur:

• Cellulitis — the infection spreads to deeper skin layers, causing swelling, redness, and warmth. Requires systemic antibiotics.
• Lymphangitis — inflammation of the lymph vessels, visible as red streaks from the infection site. Requires medical treatment.
• Post-streptococcal glomerulonephritis — a rare kidney complication that can occur 1–3 weeks after a streptococcal infection. Symptoms may include swelling, dark urine, and elevated blood pressure. Very rare, but requires medical follow-up.

Frequently Asked Questions

Can the child bathe or shower with impetigo?

Yes, the child can and should bathe or shower. Gentle washing of the sores with lukewarm water and mild soap is an important part of treatment. Avoid shared bathtubs and use separate towels.

Can impetigo come back?

Yes, impetigo does not confer immunity. The child can get impetigo multiple times, especially if they have eczema or other skin irritation that makes the skin more vulnerable.

Is impetigo contagious before symptoms appear?

Contagion is greatest when there are visible, weeping sores. Before symptoms appear (during the incubation period), the risk of contagion is very low.

Can adults get impetigo?

Yes, adults can also get impetigo, but it is far more common in children. Adults with eczema, diabetes, or weakened immune systems have an increased risk.

Should siblings stay home from daycare?

No, siblings without symptoms do not need to stay home. But be extra vigilant for early signs, and maintain good hand hygiene at home.

Can impetigo cause scarring?

Non-bullous impetigo does not usually cause scarring, since the infection only affects the outermost layer of skin. Bullous impetigo may in rare cases cause temporary skin discoloration, but permanent scarring is uncommon.

Sources

1. American Academy of Pediatrics — Impetigo
2. CDC — Impetigo: All You Need to Know
3. AAP Red Book — Group A Streptococcal Infections
4. UpToDate — Impetigo: Epidemiology, clinical features, and diagnosis