Should Your Child See a Doctor?
Impetigo – Infected Sores
- Bacterial skin infection causing 1 or more coin-shaped sores
- 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
- 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
- Impetigo is a superficial skin infection that usually starts in a scratch or insect bite.
- It usually responds to treatment with any antibiotic ointment.
- Remove Scabs: Soak off the scab using an antibacterial soap and warm water. The bacteria live underneath the scab.
- 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.
- Avoid Picking: Discourage scratching and picking which spreads the impetigo.
- 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.
- Expected Course: Sore stops growing in 1 to 2 days and skin is healed in 1 week.
- 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.
- American Academy of Pediatrics: Committee on Infectious Diseases. Impetigo. In Pickering L, ed. 2009 Red Book. 28th ed. Elk Grove Village, IL: 2009.
- 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.
- Cole C, Gazewood J. Diagnosis and treatment of impetigo. Am Fam Physician. 2007:75:859-864.
- Darmstadt GL. A guide to superficial strep and staph skin infections. Contemp Pediatr. 1997;14 (5):95-116.
- Mancini AJ. Bacterial skin infections in children: The common and the not so common. Pediatr Ann. 2000;29:26-35.
- Scales JW, Fleischer AB, Krowchuk DP. Bullous impetigo. Arch Pediatr Adolesc Med. 1997;151:1168-1169.
- Stanley JR, Amagai M. Pemphigus, bullous impetigo and the staphylococcal scalded skin syndrome. N Engl J Med. 2006;355:1800-1810.
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.