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Impetigo – Infected Sores

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Definition

  • Bacterial skin infection causing 1 or more coin-shaped sores

Symptoms 

  • Sores smaller than 1 inch in diameter
  • Often covered by a soft, yellow-brown scab or crust
  • Scabs may intermittently drain pus
  • Begin as small red bumps which rapidly change to cloudy blisters, then pimples, and finally open sores which weep
  • Increases in size (any sore or wound that grows and doesn't heal is usually impetigo)
  • Impetigo often spreads and increases in number from scratching

Cause 

  • Superficial bacterial infections of small breaks in the skin
  • The most common bacteria are Staph and Strep

Return to School 

  • For mild impetigo (1 or 2 sores), child can attend school or child care if it is covered
  • For severe impetigo, child needs to take an oral antibiotic for more than 24 hours before returning to school or contact sports

When to Call Your Doctor for Impetigo - Infected Sores

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Red or cola-colored urine
  • Red streak runs from the impetigo
  • Red tender area surrounds the impetigo
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Fever or sore throat are present
  • Large sore (larger than 1 inch across or 2.5 cm)
  • Sores and crusts are also inside the nose
  • Impetigo becomes worse after 48 hours on antibiotic ointment
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Impetigo in 2 or more children (e.g., sibs, childcare groups)
  • Child plays contact sports (Reason: to prevent spread)
  • 3 or more impetigo sores (Reason: may need an oral antibiotic because many of these children also have strep throat infection)
  • Not completely healed after 1 week on antibiotic ointment
 

Parent Care at Home If

  • 1 or 2 impetigo sores that started with cut, scratch or insect bite and you don't think your child needs to be seen (Reason: probably will respond to antibiotic ointment)
 

Home Care Advice for Mild Impetigo

  1. Reassurance:
    • Impetigo is a superficial skin infection that usually starts in a scratch or insect bite.
    • It usually responds to treatment with any antibiotic ointment.
     
  2. Remove Scabs: Soak off the scab using an antibacterial soap and warm water. The bacteria live underneath the scab.
  3. Antibiotic Ointment: Apply an antibiotic ointment 3 times per day (no prescription needed).
    • Examples are Bacitracin or Polysporin, or one you already have.
    • Cover it with a Band-Aid to prevent scratching and spread.
    • Repeat the washing, ointment and Band-Aid 3 times per day.
     
  4. Avoid Picking: Discourage scratching and picking which spreads the impetigo.
  5. Contagiousness:
    • Impetigo is contagious by skin to skin contact.
    • Wash the hands frequently and avoid touching the sore.
    • For mild impetigo (1 or 2 sores), can attend school or child care if it is covered.
    • For severe impetigo, child needs to take an oral antibiotic for more than 24 hours before returning to school.
    • Contact Sports: Generally, needs to receive antibiotic treatment for 3 days before returning to the sport. There can be no pus or drainage. Check with team's trainer if there is one.
     
  6. Expected Course: Sore stops growing in 1 to 2 days and skin is healed in 1 week.
  7. Call Your Doctor If:
    • Impetigo increases in size after 48 hours on antibiotic ointment
    • New impetigo sore occurs on antibiotic ointment
    • Not completely healed in 1 week
    • Your child becomes worse
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. American Academy of Pediatrics: Committee on Infectious Diseases. Impetigo. In Pickering L, ed. 2009 Red Book. 28th ed. Elk Grove Village, IL: 2009.
  2. Bass JW, et al. Comparison of oral cephalexin, topical mupirocin and topical bacitracin for treatment of impetigo. Pediatr Infect Dis J. 1997;16:708-709.
  3. Cole C, Gazewood J. Diagnosis and treatment of impetigo. Am Fam Physician. 2007:75:859-864.
  4. Darmstadt GL. A guide to superficial strep and staph skin infections. Contemp Pediatr. 1997;14(5):95-116.
  5. Mancini AJ. Bacterial skin infections in children: The common and the not so common. Pediatr Ann. 2000;29:26-35.
  6. Scales JW, Fleischer AB, Krowchuk DP. Bullous impetigo. Arch Pediatr Adolesc Med. 1997;151:1168-1169.
  7. Stanley JR, Amagai M. Pemphigus, bullous impetigo and the staphylococcal scalded skin syndrome. N Engl J Med. 2006;355:1800-1810.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/17/2010

Copyright 1994-2011 Barton D. Schmitt, M.D.

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