Impetigo - school sores

Impetigo is a common skin infection caused by Staphylococcus or, less commonly, Streptococcus bacteria. It is also known as "school sores" because it most often affects school-aged children. Impetigo is more common during the warmer months.

Bacteria that cause impetigo live on various parts of the body, such as the skin and in the nose, and are usually harmless. Infection occurs when the bacteria enter broken skin, such as cuts and scratches or from an underlying skin condition like eczema. Sometimes, infection can occur even in healthy intact skin.

Symptoms of impetigo

Impetigo causes skin sores. Symptoms usually start 1 to 10 days after being exposed to the bacteria that cause impetigo.

The sores usually appear as small blisters which burst and leak fluid and then form honey-coloured crusts or scabs. Sometimes the sores and blisters can be larger to cause a more serious form of impetigo. The sores can occur anywhere on the body but are most common around the mouth, nose, arms and legs.

In most people, the skin heals completely after a few days.

Complications of impetigo

Very rarely, impetigo can lead to serious infections such as cellulitis (skin infection) or bacteraemia (bloodstream infection).

Streptococcus bacteria can also cause other conditions, such as scarlet fever, and complications that affect the heart (acute rheumatic fever and rheumatic heart disease) and kidneys (post-streptococcal glomerulonephritis).

Spread of impetigo

Impetigo is highly contagious and can spread from person to person by directly touching the sores, fluid from the sores or objects and surfaces contaminated by the sores.

Cases can often occur among family members or people who live closely together. Sometimes outbreaks can occur in schools and children’s service centres.

People at risk of impetigo

Impetigo is most common in pre-school and school aged children, but can affect people of all ages.

It is also more common in people with damaged skin, such as cuts, abrasions, burns or insect bites, a pre-existing skin condition, such as eczema or dermatitis, or a weakened immune system.

Impetigo can be dangerous and life-threatening in babies and young infants as their immune system may not yet be mature to fight the infection.

Diagnosis of impetigo

Doctors usually diagnose impetigo by looking at the sores. Sometimes, they may swab and test the sores for identify the bacteria.

If your child gets impetigo repeatedly your doctor may do a nose swab to test for bacteria in the nose.

Treatment of impetigo

Take care of sores

• wash the sores with an antibacterial soap every 8 to 12 hours
• soak and gently remove any visible crusts
• after each wash, pat the sores dry using a clean towel each time
• completely cover and seal the sores with a waterproof dressing, where possible
• use a crepe bandage to hold the dressing in place or help prevent young children from scratching the sores.

Antibiotic treatment

• impetigo can be treated with antibiotic creams which should be reapplied until the sores have completely healed
• oral antibiotics, such as in liquid or tablet form, may be recommended for some infections.

If antibiotics are recommended, they should be used and completed according to the doctor's or pharmacist's instructions.

Speak to your doctor

Speak to your doctor about impetigo and treatment if:

• the sores continue to spread or new sores start to form despite treatment
• a fever develops
• your child becomes unwell.

Avoid spreading impetigo

Impetigo is highly contagious and can spread from person to person by directly touching the sores, fluid from the sores and contaminated objects and surfaces.

In particular, young children can touch or scratch the skin sores and spread the infection to other parts of the body and to other people.

Prevent the spread of impetigo

• avoid touching the sores and keep them clean and covered with a waterproof dressing where possible, using a crepe bandage if necessary
• wash your hands with soap and water before and after touching, cleaning or applying treatment on the sores and after handling contaminated objects such as dressings, sheets, towels or utensils
• use a clean cloth each time to wash and dry the sores
• dispose of used dressings as soon as they are removed into a waste bin
• avoid sharing clothes, sheets, towels or utensils with anyone who has impetigo
• avoid bathing children in the same bathwater as a child with impetigo
• wash clothes, sheets, towels and utensils that have been used by someone with impetigo every day, ideally in hot water
• keep your child’s fingernails short and clean and encourage them not to touch or scratch the sores
• keep children with impetigo at home from school or childcare centres until antibiotic treatment has been started. All sores on exposed skin must be covered with a waterproof dressing when returning.

Information for schools and children’s services

Children with impetigo must stay at home from school and children’s services, such as childcare centres and kindergarten, until antibiotic treatment has been started.

• educate staff, parents and children about the importance of hand washing, covering skin lesions and staying home if unwell
• when children return after commencing treatment, ensure skin lesions on exposed areas of the skin are covered with a waterproof dressing, where possible
• advise staff and parents who may have had direct contact with impetigo skin lesions to monitor for symptoms and signs of impetigo and seek medical care if they develop
• clean and disinfect any commonly used or shared objects and surfaces, such as equipment, desks and toys
• encourage children not to share personal items such as clothes, towels, bed linen, drink bottles or utensils.

Resources on preventing infectious diseases in childcare settings can be found at the Staying Healthy: Preventing infectious diseases in early childhood education and care services webpage.

Where to get help

• Your GP (doctor)
• Your pharmacist
• Your local maternal and child health nurse
• Urgent Care Clinics– when immediate healthcare is needed but it's not life-threatening
• Virtual Emergency Care
• Maternal and Child Health Line 13 22 29 (24 hours, 7 days)
• NURSE-ON-CALL 1300 60 60 24 (24 hours, 7 days)
• Impetigo (school sores), Royal Children’s Hospital Melbourne.