Impetigo in Children: Spotting Honey-Coloured Crusts and Stopping the Spread

It started with a little spot under the nostril, which your son scratched. Two days later, the area weeps and is covered with a yellow, slightly shiny crust, and a second patch appears at the corner of his mouth. This picture has a name: impetigo. It is the most common bacterial skin infection in children, especially between ages 2 and 5.

It is not usually serious, but it is very contagious and does not heal well on its own if left alone. Here is how to recognise it, what the doctor will suggest and the habits that stop it passing to all the siblings.

What does impetigo look like?

Impetigo is recognised above all by its honey-coloured crusts, which dermatologists call “melicerous”. The UK’s NHS compares them to cornflakes stuck to the skin. It all starts with small red patches or fluid-filled blisters that burst, weep for a few days, then dry into a crust.

It most often appears on the face, around the nose and mouth, but also on the hands, arms, legs and sometimes the bottom. The lesions can itch, sometimes hurt a little, and spread if the child scratches. On brown or dark skin, redness is less visible: go by the crusts and the weeping instead.

There is also a bullous form, with large clear blisters that leave red, moist sores. It too ends up forming crusts.

What can look like it

A cold sore (herpes) near the lips, an infected patch of eczema, chickenpox or the spots of childhood rashes can cause confusion. The diagnosis is usually made at a glance at the doctor’s, without a blood test.

Where does impetigo come from, and why does nursery see so much of it?

It is caused by common bacteria, mostly Staphylococcus aureus and sometimes streptococcus, which already live on the skin or in the nose. They take advantage of an entry point: a scratch, a scratched mosquito bite, a patch of eczema, a nose irritated by a cold, or even chickenpox and the scratch marks linked to head lice.

It then spreads through direct skin-to-skin contact, and through towels, bed linen or toys. The CDC lists group settings for children, hot and humid climates and small summer wounds among the risk factors. In other words, a Moroccan summer with grazed knees, mosquitoes and group play ticks a lot of boxes. Children with atopic skin, whose eczema itches, are also more exposed: our article on eczema and cradle cap helps keep that skin in good shape.

What treatment for impetigo?

Impetigo is treated with an antibiotic prescribed by the doctor, and the choice depends on how widespread the lesions are. The French National Authority for Health (HAS) distinguishes:

The duration and number of applications are set by the doctor: follow the prescription to the end, even if the skin seems healed before. The NHS adds that babies and fragile children are more often given treatment by mouth, to avoid complications.

Do not reuse an old antibiotic ointment found in the cupboard, and do not put some on every spot “just in case”: an antibiotic used wrongly encourages resistance.

Home care: simple and regular

The basic care is surprisingly simple. The HAS recommends washing the lesions with soap and water, once or twice a day, and specifies that antiseptics added to this washing are not recommended. No need, then, to stain your child’s face with colour or multiply products.

To limit scratching, keep their nails very short, with small round-tipped scissors for example, and keep their hands busy. The more they scratch, the more the infection spreads and the higher the risk of marks.

How do you stop the whole family catching it?

By cutting the bacterium’s routes, at home and elsewhere. The NHS advises:

• a towel and washcloth kept for the sick child;
• sheets, pillowcases and towels washed at high temperature;
• toys washed in lukewarm soapy water;
• frequent hand washing, for the child and for whoever does the care;
• avoiding close contact with infants and with people who have diabetes or are fragile;
• no sharing of bath, hammam or water bottle during the contagious phase.

According to the NHS, impetigo stops being contagious 48 hours after treatment starts. Untreated, it can stay contagious for one to three weeks, until all the lesions are dry.

Nursery, school: should my child stay home?

Rules vary from country to country. In France, the HAS provides for exclusion for 3 days after treatment starts only if the lesions cannot be covered with a dressing; otherwise the child can return to the group. The US CDC allows a return as soon as treatment has begun and all visible sores are covered. The NHS, more cautious, advises staying home until the end of contagiousness, that is 48 hours of treatment.

In Morocco, each nursery applies its own rules: ask for them, tell the staff and keep the doctor’s certificate if you are asked for one. Most small nursery outbreaks are settled this way, as we explain in our article on nursery illnesses.

Are complications possible?

They are rare when impetigo is treated. The most common is spread of the infection to the deeper layers of the skin (cellulitis), which shows as a red, warm, swollen, painful area that keeps spreading, often with fever. When streptococcus is involved, the CDC describes very rare, delayed complications affecting the kidneys (glomerulonephritis) or the heart and joints (acute rheumatic fever). This is one of the reasons impetigo is treated rather than waiting for it to pass.

Small pearly spots that do not crust over are often another skin infection: see our article on molluscum contagiosum.