Impetigo is one of the most common skin infections seen in UK general practice and pharmacies, especially in young children, though anyone can get it. It looks alarming when it first appears, with crusted, weeping patches that can spread quickly to other family members, but it is usually straightforward to treat once you know which type you're dealing with and how to stop it passing on.
This guide covers what causes impetigo, how to tell non-bullous and bullous impetigo apart, the topical and oral treatment options used in the UK, and the hygiene steps that keep it from spreading through a household, nursery or classroom.
What impetigo is and how it spreads
Impetigo is a bacterial skin infection caused by Staphylococcus aureus, Streptococcus pyogenes, or a combination of the two. The bacteria get into the skin through a small break, such as a cut, insect bite, area of eczema or patch of cold sore, though impetigo can also start on skin that looks otherwise healthy. It's most common in young children, particularly in the warmer months and in settings like nurseries and schools where close contact is frequent, but it can affect people of any age.
It spreads easily through direct contact with the sores themselves, or indirectly through anything that has touched them, including towels, flannels, bedding, toys and clothing. Because the sores are full of bacteria, even brief contact, such as a child touching a sore and then a toy, can be enough to pass it on. This is why impetigo tends to move quickly through households, classrooms and sports teams once one person is affected.
Impetigo can happen on its own (primary impetigo) or as a complication of an existing skin problem such as eczema, scabies or a cold sore that has become infected (secondary impetigo). Either way, the treatment approach is broadly the same, though any underlying skin condition also needs its own management to reduce the chance of it happening again.
Recognising the symptoms: non-bullous vs bullous impetigo
There are two main forms of impetigo, and telling them apart helps guide treatment. Non-bullous impetigo is the more common form. It starts as small red sores, often around the nose and mouth, though it can appear anywhere on the body. These sores quickly burst and ooze, then dry to form a characteristic golden or honey-coloured crust. It isn't usually painful, though it can be itchy, and most people feel otherwise well.
Bullous impetigo is less common and is caused by a toxin produced by Staphylococcus aureus. It causes larger, more fragile fluid-filled blisters that can appear on the trunk, arms, legs, or, in babies, the nappy area. These blisters burst more easily than non-bullous sores and leave behind a thinner, flatter, brownish crust rather than the thick golden one seen in non-bullous impetigo. Bullous impetigo is somewhat more likely to affect newborns and infants, and it's still generally straightforward to treat once recognised.
In both types, new patches can appear near the original one as the infection spreads across the skin, and scratching an itchy patch can carry bacteria to a new area or into a cut. A pharmacist or GP can usually diagnose impetigo from how it looks and where it is, without needing further tests, though they may ask about recent skin injuries, eczema or contact with anyone else who has had it.
Treating impetigo: fusidic acid cream and the Pharmacy First route
For localised, non-bullous impetigo affecting a small area of skin, topical treatment is usually all that's needed. Fusidic acid 2% cream is the standard first-line option, applied directly to the affected skin as directed, typically for around five days. It works by targeting the bacteria causing the infection at the site of the sores, without the wider effects of a tablet taken by mouth.
In England, many pharmacies now offer this as part of the NHS Pharmacy First service, which lets a trained pharmacist assess localised impetigo and supply fusidic acid cream directly, without a separate GP appointment, for people who meet the service's eligibility criteria. This is often the fastest and most convenient route to treatment, particularly for parents managing a child's impetigo around a busy week.
Good technique matters even with a topical treatment: wash your hands both immediately before applying the cream and again once you're done, use a clean finger or applicator each time, and avoid touching the sores unnecessarily between applications. Keeping the area clean with plain water and gently removing loose crusts, where advised, can also help the cream reach the skin underneath.
When oral antibiotics are needed
Topical treatment isn't right for everyone. Oral antibiotics, most commonly flucloxacillin, are used when impetigo is widespread across more than one area of the body, when it's the bullous type, when the person is systemically unwell (for example with a fever), or when localised impetigo hasn't improved after 2 to 3 days of correctly applied topical treatment. A short course, usually around 5 to 7 days, is typical, and it's important to finish it even once the sores start to look better.
For people who are allergic to penicillin, an alternative antibiotic such as clarithromycin or erythromycin can be used instead. Your pharmacist or GP will choose the option that's most appropriate for your circumstances, including any other medicines you take and, for children, their age and weight.
If oral antibiotics are prescribed, the topical fusidic acid cream isn't usually needed at the same time, since the tablets treat the infection throughout the body. Your clinician will explain exactly what to use and for how long, based on how widespread the infection is.
Stopping the spread: hygiene, school and work
Because impetigo spreads so easily through direct and indirect contact, a few simple hygiene steps make a real difference alongside treatment. The standard UK advice is to stay away from school, nursery or work until the sores have crusted over and healed, or until 48 hours have passed since starting antibiotics, whichever applies. This exclusion period is designed to stop it passing to others while the infection is still active.
At home, avoid sharing towels, flannels, bedding, cutlery and cups with anyone affected until the infection has cleared, and wash these items separately at a hot temperature. Encourage regular handwashing, keep nails short to reduce the temptation to scratch, and try to cover sores with loose clothing or a light dressing where practical, without trapping moisture underneath.
If more than one person in a household or classroom develops impetigo, it's worth thinking about how they may be picking it up from each other, such as a shared towel or close contact during play, and adjusting those habits while everyone recovers. Impetigo itself doesn't reflect poor hygiene, it simply spreads very efficiently between people in close contact, so there's no need for embarrassment, just sensible precautions while it clears.
When to see a doctor
Most impetigo clears well with the treatment described above, but it's worth seeking medical advice if the skin around the sores becomes increasingly red, swollen, warm or painful, which can point to a deeper infection such as cellulitis. Also see a doctor if there's a fever or you feel generally unwell, if the impetigo hasn't improved despite correctly used treatment, if it keeps coming back, or if it affects a very young baby, someone who is pregnant, or someone with a weakened immune system.
A pharmacist is a good first port of call for straightforward, localised impetigo in an otherwise well person, and can advise when it's appropriate to step up to a GP assessment instead. If you're ever unsure how quickly you need to be seen, NHS 111 can help you decide.