Impetigo - Infected Sores

Pediatric HouseCalls Online

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 covererd
• For severe impetigo, child needs to take an oral antibiotic for more than 24 hours before returning to school or contact sports

See More Appropriate Topic (instead of this one) If

• It's in a wound, see WOUND INFECTION
• Doesn't look like impetigo, see RASH - LOCALIZED AND CAUSE UNKNOWN

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 9am and 4pm) 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).
• 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. Remove Scabs:  Soak off the scab using an antibacterial soap and warm water.  The bacteria live underneath the scab.
2. 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.
3. Avoid Picking:  Discourage scratching and picking which spreads the impetigo.
4. Contagiousness:  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 or contact sports.
5. Expected Course:  Sore stops growing in 1 to 2 days and skin is healed in 1 week.
6. 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 docor if your child develops any of the "Call Your Doctor" symptoms.