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Impetigo - infected sores

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Impetigo of Left Cheek
Impetigo of Left Cheek

Impetigo of Elbow
Impetigo of Elbow

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

Return to School

  • For mild impetigo (1 or 2 sores), child can attend school or day 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

If not, see these topics

When to Call Your Doctor

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.
    • Use Bacitracin or Polysporin ointment 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 day 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 "Call Your Doctor" symptoms.

Disclaimer: This information is not intended 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: 1/19/2009

Last Revised: 8/5/2007

Content Set: Pediatric HouseCalls Online

Copyright 1994-2009 Barton D. Schmitt, M.D.

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