Impetigo is a common, highly contagious bacterial skin infection that affects babies and young children more than any other age group. It looks alarming — the distinctive honey-coloured crusts are hard to miss — but it is treatable, and most cases resolve completely within a week or two with appropriate management.
Impetigo is caused by bacteria, most commonly Staphylococcus aureus (staph) or, less frequently, Streptococcus pyogenes (strep). These bacteria infect the superficial layers of the skin, typically entering through a break in the skin such as a scratch, insect bite, or area of eczema. In babies, the skin around the nose and mouth is the most common site, but impetigo can appear anywhere.
There are two main types:
This starts as small red sores or blisters that quickly burst, leaving a raw-looking area beneath. The fluid dries to form the characteristic honey-coloured or golden-brown crusts — sometimes described as resembling cornflakes stuck to the skin. The crusts typically appear around the nose and mouth but can spread to other areas.
This presents as larger fluid-filled blisters that may be clearer or yellowish. They burst less readily and leave a raw, red area. Bullous impetigo is more commonly caused by specific strains of S. aureus.
Both types may be associated with mild swollen lymph nodes nearby. A temperature is uncommon but possible in more extensive infections.
Very. Impetigo spreads easily through direct contact with the sores or with items that have touched them — towels, flannels, clothing, toys. It can also spread when a person touches their own sores and then touches another person or surface.
This is why exclusion from nursery and childcare settings is important, and why all household members should avoid touching the affected skin and wash hands frequently. Each person in the household should use separate towels.
For mild to moderate impetigo affecting a small area, a topical antibiotic cream is the first-line treatment. The most commonly prescribed in the UK is fusidic acid cream (brand name Fucidin), applied three times daily for five to seven days.
Hydrogen peroxide 1% cream (Crystacide) is a non-antibiotic topical agent that is now recommended by NICE as an alternative first-line option for non-bullous impetigo, in order to reduce antibiotic resistance. It is available on prescription.
Apply the cream to the affected area and gently remove any crusts beforehand (softening with a damp cloth helps) to allow the cream to reach the bacteria underneath.
Oral antibiotics are used when:
Flucloxacillin is typically the first choice. If the baby has a penicillin allergy, cefalexin or clarithromycin may be used instead.
Always complete the full course of antibiotics, even if the sores appear to have cleared.
This is one of the most common questions parents ask. Current Public Health England (UKHSA) guidance states that:
This means that once you have started a course of antibiotic cream or oral antibiotics and 48 hours have passed, your baby can return to nursery even if the sores are not completely healed. Inform the nursery so they can maintain good hygiene practice.
Most cases of impetigo are mild and managed in primary care. However, seek urgent advice if:
With prompt treatment, impetigo in babies heals well, and it does not scar in the vast majority of cases.
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