Children with impetigo can return to school 24 hours after starting antibiotic therapy as long as their draining lesions are covered. Treatment
Antibiotics, either as a cream or by mouth, are usually prescribed. Mild cases may be treated with mupirocin ointments. In 95% of cases, a single 7-day antibiotic course results in resolution in children. It has been advocated that topical antiseptics are inferior to topical antibiotics, and therefore should not be used as a replacement. However, the National Institute for Health and Care Excellence (NICE) as of February 2020 recommends a hydrogen peroxide 1% cream antiseptic rather than topical antibiotics for localised non-bullous impetigo in otherwise well individuals. This recommendation is part of an effort to reduce the overuse of antimicrobials that may contribute to the development of resistant organisms such as MRSA. More severe cases require oral antibiotics, such as dicloxacillin, flucloxacillin, or erythromycin. Alternatively, amoxicillin combined with clavulanate potassium, cephalosporins (first-generation) and many others may also be used as an antibiotic treatment. Alternatives for people who are seriously allergic to penicillin or infections with methicillin-resistant Staphococcus aureus include doxycycline, clindamycin, and trimethoprim-sulphamethoxazole, although doxycycline should not be used in children under the age of eight years old due to the risk of drug-induced tooth discolouration. When streptococci alone are the cause, penicillin is the drug of choice.When the condition presents with ulcers, valacyclovir, an antiviral, may be given in case a viral infection is causing the ulcer. Alternative medicine
There is not enough evidence to recommend alternative medicine such as tea tree oil or honey.
Signs and symptoms
Contagious impetigo
This most common form of impetigo, also called nonbullous impetigo, most often begins as a red sore near the nose or mouth which soon breaks, leaking pus or fluid, and forms a honey-colored scab, followed by a red mark which often heals without leaving a scar. Sores are not painful, but they may be itchy. Lymph nodes in the affected area may be swollen, but fever is rare. Touching or scratching the sores may easily spread the infection to other parts of the body.Skin ulcers with redness and scarring also may result from scratching or abrading the skin. Bullous impetigo
Bullous impetigo, mainly seen in children younger than 2 years, involves painless, fluid-filled blisters, mostly on the arms, legs, and trunk, surrounded by red and itchy (but not sore) skin. The blisters may be large or small. After they break, they form yellow scabs. Ecthyma
Ecthyma, the nonbullous form of impetigo, produces painful fluid- or pus-filled sores with redness of skin, usually on the arms and legs, become ulcers that penetrate deeper into the dermis. After they break open, they form hard, thick, gray-yellow scabs, which sometimes leave scars. Ecthyma may be accompanied by swollen lymph nodes in the affected area. Causes
Impetigo is primarily caused by Staphylococcus aureus, and sometimes by Streptococcus pyogenes. Both bullous and nonbullous are primarily caused by S. aureus, with Streptococcus also commonly being involved in the nonbullous form. Predisposing factors
Impetigo is more likely to infect children ages 2–5, especially those that attend school or day care.