Impetigo: The Staph Skin Infection Common in Kids

What is impetigo?

Impetigo is a bacterial skin infection caused by group A Streptococcus, Staphylococcus aureus, or both.¹ It’s most common in children 2 through 5 years old, but anyone can get it.¹⁴ In older kids and adults, it often starts when a cut, insect bite or skin condition like eczema breaks the skin and gives the bacteria a way in.²

It’s usually mild, and the sores normally heal without scarring.¹ The main challenge is that it spreads easily, to other parts of the body and to other people, so it’s worth getting it checked early.

What impetigo looks like

Impetigo often shows up on the face, especially around the nose, mouth and ears. It’s also common on the arms and legs.⁴ There are three main types:

• Crusted (non-bullous) impetigo is the most common. Red, itchy sores break open, ooze for a few days, then dry into yellow or “honey-colored” crusts.¹³
• Bullous impetigo causes larger blisters filled with clear, cloudy or yellow fluid. These may burst and leave moist, red sores that crust over.³⁴
• Ecthyma is a more serious form. It goes deeper into the skin, causing painful sores that can leave scars.²³

The sores are often itchy. Other rashes can look similar, especially in the early stages, so let your child’s doctor make the call rather than guessing from photos online.

How it spreads and who gets it

Close contact with someone who has impetigo is the most common way to catch it.¹ It can also spread through items that touched the sores, such as towels and clothing.² The infection can also spread to other areas of the body.³ It tends to pop up more in warm weather, when children are outside more and pick up more cuts and scrapes.⁴

Things that raise the odds include:¹²

• Being 2 to 5 years old
• Crowded places like daycare, school and shelters
• Hot, humid weather
• Broken skin from cuts, insect bites or rashes
• Skin conditions such as eczema

When group A strep is the cause, sores usually appear about 10 days after exposure.¹ For more on staph in young children, see staph in kids.

Treatment and going back to school

Impetigo is treated with antibiotics, either a cream or ointment on the skin or medicine by mouth, depending on how widespread it is.⁴ Your child’s doctor will decide which is right. Use the full course exactly as directed, even once the sores look better.

Advice on returning to school or daycare varies a little. The CDC says children can go back once they’ve started antibiotic treatment, as long as all sores on exposed skin are covered.¹ Mayo Clinic suggests keeping kids home until they’re no longer contagious, usually 24 hours after starting antibiotics.² The American Academy of Pediatrics advises avoiding close contact with other children until the rash is clearing or has improved after two days of antibiotics.⁴ Check with your pediatrician and your child’s school or daycare, since many have their own rules.

Stopping the spread at home

While your child heals, these steps help keep impetigo from spreading to the rest of the family:²⁴

• Gently wash the sores with mild soap and running water, then cover them lightly with gauze.
• Wash your child’s towels, washcloths and bedding daily in hot water, separate from everyone else’s.
• Wear gloves when applying any medicine to the sores, and wash your hands afterward.
• Keep your child’s nails short, and encourage them not to pick at sores or scabs.
• Have everyone in the house wash their hands often.

When to see a doctor

If you think your child has impetigo, call your pediatrician, family doctor or a dermatologist.² It needs a diagnosis, because the treatment is a prescription antibiotic.⁴ Call sooner, or call back, if you notice:

• Sores that are spreading or not improving after a few days of treatment
• Deep, painful sores, which may be ecthyma³
• Redness, warmth or swelling spreading around the sores, which can mean the infection has moved deeper into the skin²
• Fever, or a child who seems unusually tired or unwell
• Any sores or blisters on a newborn or young baby

Rarely, impetigo caused by group A strep can lead to kidney problems.¹ If your child seems unwell in the weeks after impetigo clears up, let the doctor know. Get urgent care or call 911 for a child who is very sleepy, hard to wake, or struggling to breathe.