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Health condition · Clinically reviewed

Impetigo, honey crusts, hydrogen peroxide and when antibiotics are needed.

A common, highly contagious skin infection in children. Modern UK treatment is a step-up ladder from hygiene through topical antiseptic to targeted antibiotics.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BAD and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including hydrogen peroxide first-line and short-course topical antibiotics.

Key facts

Impetigo at a glance.

The essentials, in plain English - what causes it, how to spot the different forms, and how it is treated in the UK today.

  • What it is

    A superficial bacterial skin infection, common in children and highly contagious through direct contact and shared items.

  • The bugs

    Staphylococcus aureus in the majority of cases, with Streptococcus pyogenes (Group A strep) in a proportion.

  • Non-bullous

    The commonest form (around 70 per cent) - honey-coloured golden crusts on an erythematous base, often around the mouth and nose.

  • Bullous

    Flaccid clear or yellow bullae that rupture - driven by a Staph aureus exfoliative toxin, seen in infants and skin folds.

  • Ecthyma

    A deeper form with punched-out ulcers and thick crust - warrants specialist input and closer follow-up.

  • First-line

    Topical hydrogen peroxide 1 per cent (Crystacide) for localised non-bullous disease, per NICE 2020 guidance.

Why this guide matters

A stepped plan, not a rush to antibiotics.

Impetigo is common, contagious and, in most cases, straightforward to treat. The three points below shape everything else on this page.

  • Hygiene is half the treatment

    Hand-washing, separate towels and covered lesions matter as much as any cream - both for healing and for stopping the spread.

  • Antibiotic stewardship

    NICE 2020 puts hydrogen peroxide 1 per cent first for localised disease - saving topical and oral antibiotics for the cases that truly need them.

  • Recurrence needs a rethink

    Repeat episodes call for swabs, nasal carriage checks and, sometimes, decolonisation of the household - not just another prescription.

How the diagnosis is made

From first crusts to a clear plan.

The steps a UK GP or dermatologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Clinical pattern recognition

    Impetigo is a clinical diagnosis - honey crusts, flaccid bullae or punched-out ulcers usually tell the story on inspection alone.

  2. 02

    Assessing

    Distribution and spread

    A close look at the face, hands, nose and skin folds - plus a check for auto-inoculation elsewhere and regional lymphadenopathy.

  3. 03

    Assessing

    Systemic review

    Fever, malaise or extensive disease suggest bullous impetigo or a more invasive infection - lowering the threshold for oral antibiotics.

  4. 04

    Confirming

    Skin swab and culture

    Reserved for recurrent, resistant or extensive disease - identifies the organism and its antibiotic sensitivities, including MRSA.

  5. 05

    Confirming

    Nasal carriage screen

    In recurrent cases a nasal swab looks for Staph aureus carriage - the reservoir behind repeated skin infection.

  6. 06

    Onward

    Safeguarding review

    Recurrent, atypical or neglected-appearing infection prompts a wider paediatric or safeguarding assessment.

  7. 07

    Onward

    Specialist dermatology referral

    Ecthyma, treatment failure, MRSA, or a suspicion of staphylococcal scalded skin syndrome warrants specialist review.

Typical timeline: most uncomplicated impetigo settles within 7 to 10 days of treatment.

Symptoms

What impetigo actually looks like.

The classic mix of honey-coloured crusts, blisters and rapid spread - and the features that mean it is time to escalate.

  • Honey-coloured crusts

    The classic sign of non-bullous impetigo - golden, sticky crusts on an erythematous base, usually around the mouth and nose.

  • Erythematous macules and papules

    Early lesions before crusting - small red spots that quickly break down and weep.

  • Flaccid bullae

    Clear or yellow fluid-filled blisters that rupture easily - the hallmark of bullous impetigo, driven by an exfoliative toxin.

  • Punched-out ulcers (ecthyma)

    Deeper, sharply defined ulcers with a thick adherent crust - a more severe form needing specialist input.

  • Rapid spread and auto-inoculation

    New lesions appear where fingers, towels or clothing have touched infected skin - a key reason infection travels quickly.

  • Itch (pruritus)

    Lesions are often itchy - scratching seeds the bacteria into new sites and delays healing.

  • Regional lymphadenopathy

    Tender, swollen lymph nodes near the infected area - a marker of a more active immune response.

  • Red flag - systemic illness or spread

    Fever, extensive bullae, rapidly spreading redness or a peeling rash beyond the lesion needs urgent medical assessment.

Treatment

How impetigo is treated in the UK.

Hygiene first, hydrogen peroxide next for localised disease, then targeted topical or oral antibiotics for extensive, bullous or resistant infection.

  • Skin hygiene and containment

    Hand-washing, separate towels and flannels, gentle cleansing of crusts and keeping children off school until 48 hours of treatment or full healing.

  • Hydrogen peroxide 1 per cent

    First-line for localised non-bullous impetigo per NICE 2020 - a topical antiseptic (Crystacide) applied two to three times daily.

  • Topical fusidic acid 2 per cent

    A short-course topical antibiotic when Staph aureus is suspected and hydrogen peroxide is unsuitable or has failed.

  • Topical mupirocin (Bactroban)

    Reserved for suspected or confirmed MRSA - typically prescribed under specialist advice to protect its usefulness.

  • Oral flucloxacillin

    The oral antibiotic of choice for extensive, bullous or systemically unwell disease - covers Staph aureus effectively.

  • Oral clarithromycin

    A macrolide alternative for penicillin-allergic patients - equally effective for typical Staph and Strep skin infection.

  • Co-trimoxazole or doxycycline

    Options for oral treatment of MRSA-related impetigo - selected on culture and sensitivity, under specialist guidance.

  • Decolonisation and follow-up

    Nasal mupirocin and antiseptic washes for recurrent cases and household carriers - guided by specialist microbiology.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or dermatologist knows your skin and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Impetigo: antimicrobial prescribing (NG153, 2020).

  • British Association of Dermatologists (BAD). Patient information leaflets on impetigo.

  • British Society for Paediatric Dermatology (BSPD). Guidance on childhood skin infection.

  • NICE CKS. Impetigo - clinical knowledge summary.

Red flags

When impetigo needs urgent attention.

Most impetigo settles with hygiene and topical treatment. These are the situations that need same-day medical review or a specialist opinion.

  • Rapidly spreading redness

    Diffuse, warm, tender redness beyond the crusted area suggests cellulitis - see our cellulitis guide - and needs prompt oral antibiotics.

  • Lymphangitis

    A visible red streak tracking from the infection towards a lymph node signals deeper spread and needs same-day medical review.

  • Systemic illness in a child

    Fever, drowsiness, poor feeding or a widespread rash calls for urgent assessment - do not manage this at home.

  • Staphylococcal scalded skin syndrome

    A widespread peeling rash in an infant or young child is an emergency - specialist paediatric and dermatology care is needed straight away.

  • Recurrent or resistant infection

    Repeat episodes despite adequate treatment warrant swabs, culture and consideration of nasal carriage or MRSA.

  • Ecthyma

    Punched-out ulcers with thick crust need oral antibiotics, wound care and specialist follow-up to prevent scarring.

  • Post-streptococcal glomerulonephritis

    A rare late complication of Group A strep impetigo - dark urine, swelling or high blood pressure needs urgent review.

  • Rheumatic fever (rare)

    Very uncommon after skin infection but reported - joint pain, fever or a new murmur after impetigo warrants medical review.

  • Neonatal impetigo

    Any suspected impetigo in a newborn is treated as serious - urgent paediatric assessment is standard practice.

Living with it

A treatable infection, with a clear routine.

Four things that make the biggest difference day to day - careful hygiene, sensible time off school, gentle skin care and knowing when to come back for review.

A quiet reminder

Small, consistent habits stop the spread.

Impetigo travels on hands, towels and toys - not through the air. Simple, steady hygiene beats any single miracle cream.

  1. 01 Hygiene

    Keep hands and towels separate

    Frequent hand-washing, dedicated towels and flannels, and daily changes of bed linen dramatically reduce spread within a household.

  2. 02 School

    Time away from school or nursery

    Children should stay off school or nursery until 48 hours of antibiotic treatment or until the lesions have crusted over and healed.

  3. 03 Skin

    Gentle care of the crusts

    Soak crusts off with warm water and a clean cloth before applying treatment - do not pick, and keep the area covered where practical.

  4. 04 Escalate

    Know when to come back

    No improvement in five to seven days, new bullae, fever or spreading redness are all reasons to seek review, not to wait it out.

Frequently asked

Everything we get asked about impetigo.

Quick answers on causes, types, treatment and time off school.

  • What is impetigo?

    Impetigo is a superficial bacterial infection of the skin, most commonly caused by Staphylococcus aureus and sometimes Streptococcus pyogenes (Group A strep). It is common in children and highly contagious - spreading through direct contact and shared towels, clothing and toys.

  • What are the different types of impetigo?

    There are three forms. Non-bullous impetigo (around 70 per cent of cases) shows honey-coloured golden crusts on an erythematous base, usually around the mouth and nose. Bullous impetigo produces flaccid clear or yellow bullae that rupture, driven by a Staph aureus toxin. Ecthyma is a deeper form with punched-out ulcers and thick crust that needs specialist input.

  • How is impetigo diagnosed?

    Impetigo is a clinical diagnosis - the pattern of honey crusts, bullae or ulcers is usually enough. Skin swabs and cultures are reserved for recurrent, resistant or extensive disease, or where MRSA is suspected, so treatment can be adjusted to the organism and its sensitivities.

  • What is the first-line treatment in the UK?

    For localised non-bullous impetigo (fewer than around five lesions), NICE 2020 guidance recommends topical hydrogen peroxide 1 per cent cream (Crystacide) first line. Topical fusidic acid is an alternative when Staph aureus is suspected, and topical mupirocin is reserved for MRSA under specialist advice.

  • When are oral antibiotics needed?

    Oral antibiotics are used for extensive disease, bullous impetigo, ecthyma, systemic symptoms or when topical treatment has failed. Flucloxacillin is the usual first choice for Staph aureus, with clarithromycin for penicillin allergy. MRSA is treated with co-trimoxazole or doxycycline under specialist guidance.

  • When can my child return to school?

    Children should stay off school or nursery until 48 hours after starting antibiotic treatment, or until all the lesions have crusted over and fully healed if they are not on antibiotics. Careful hand-washing and separate towels help prevent spread to siblings and classmates.

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