Impetigo: Symptoms, Causes, and Treatment in the UK

Impetigo is a common and highly contagious bacterial skin infection. While it is often associated with young children—earning it the nickname 'school sores'—it can affect people of any age. The infection occurs when bacteria, typically Staphylococcus aureus or Streptococcus pyogenes, invade the skin through small cuts, insect bites, or areas of eczema.

In the UK, impetigo is one of the most frequent skin infections seen by GPs. It is generally not serious, but because it spreads so easily through physical contact or shared items like towels and toys, prompt diagnosis and treatment are essential to contain outbreaks in households and schools.

There are two main types of impetigo, each with slightly different clinical presentations. Recognising these early can help you seek the correct treatment faster.

Non-bullous Impetigo

This is the most common form. It usually begins with small red sores, often around the nose and mouth, though they can appear anywhere on the body. These sores quickly rupture and weep fluid before drying into a distinctive honey-coloured or golden crust. The skin underneath may remain red and inflamed but usually heals without scarring once the infection is treated.

Bullous Impetigo

More common in babies and young children, this type involves the formation of fluid-filled blisters (bullae). These blisters are usually painless but can be itchy. They tend to occur on the trunk (the central part of the body) between the waist and neck. After a few days, the blisters burst and leave a crust behind. Fever and swollen glands are more common with bullous impetigo than with the non-bullous variety.

The bacteria responsible for impetigo live harmlessly on many people's skin or in their noses. Infection occurs when the bacteria enter the skin through a break in the protective barrier. Common 'entry points' include:

• Cuts, grazes, or abrasions.
• Insect bites or stings.
• Skin conditions like eczema, scabies, or herpes simplex (cold sores).

Risk factors that increase the likelihood of contracting impetigo include living in crowded environments, participating in contact sports (like rugby or wrestling), and having a weakened immune system. Warm, humid weather also tends to see a rise in cases across the UK.

Because impetigo is so infectious, hygiene is the most important tool for management. You are considered infectious until the sores have crusted over and dried, or until 48 hours after starting antibiotic treatment.

To stop the spread:

• Do not share: Keep towels, flannels, bed linen, and clothing separate from other family members.
• Wash hands frequently: Especially after touching the affected area or applying cream.
• Avoid touching: Do not scratch or pick at the sores, as this spreads bacteria to other parts of your body or onto surfaces.
• Stay home: Children should stay away from school or nursery, and adults should stay away from work, until they are no longer contagious.
• Clean surfaces: Regularly disinfect toys and door handles.

If the infection is very mild and localised to one small area, a GP might suggest keeping the area clean and waiting to see if it resolves. However, in most cases, a short course of antibiotics is prescribed to speed up recovery and reduce the window of contagiousness.

Antibiotic Creams (Topical): For minor infections, creams containing fusidic acid or hydrogen peroxide cream are often the first line of treatment. These are applied directly to the sores several times a day.

Antibiotic Tablets (Oral): If the impetigo is widespread, severe, or if the patient has bullous impetigo, a GP may prescribe oral antibiotics such as flucloxacillin or clarithromycin. It is vital to finish the entire course, even if the skin begins to look better within a day or two.

If you suspect you or your child has impetigo, you should seek medical advice promptly. While the condition is rarely dangerous, it requires a professional diagnosis to distinguish it from other skin conditions like cellulitis or shingles.

An online GP consultation is often the most convenient way to manage impetigo because:

• You can show the rash or sores via a high-quality video link or photos.
• You avoid the risk of spreading the infection to others in a physical waiting room.
• Prescriptions for antibiotic creams or tablets can be sent directly to a local pharmacy for collection.

Our clinicians can provide a diagnosis, explain the correct way to apply treatments, and issue a sick note or advice on when it is safe to return to school or work.