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Skin irritations can be difficult to manage, especially when caused by a bacterial infection like impetigo. Red, fluid-filled blisters that itch and ooze are trademark symptoms of this infectious skin disease, which can be easily contracted in young children while on the playground, at daycare, or even in the school classroom. Luckily, this skin condition is treatable with the help of antibacterials. Let’s take a look at what causes impetigo, and what can be done to treat it.
What is impetigo?
Impetigo (also called school sores) is a bacterial skin infection common among infants and children. This highly contagious condition affects the nose and mouth in particular but may also spread to the hands and feet. Symptoms of impetigo include red sores that eventually burst and create a yellow crust.
There are nearly 3 million cases of impetigo reported in children each year and a small number of adult cases as well. Fortunately, this infection can be cured with treatments like antibiotic cream or topical ointment that can be applied directly to the affected area. In more severe cases, a patient may be prescribed an oral antibiotic to help clear up the infection.
How is impetigo diagnosed?
Staphylococcal and streptococcal infections cause impetigo, and these bacteria strains can be transferred via skin to skin contact. This skin condition can develop in normal skin, or it can infect damaged skin. While this skin infection mainly affects children between the ages of 2 and 5, adults can also contract impetigo.
Since impetigo primarily affects young children, a pediatrician is the first point of contact for many patients. Any general practitioner will be able to diagnose a case of impetigo and prescribe adequate medications to help clear up the infection. However, a patient may be referred to a dermatologist since they specialize in the treatment and diagnosis of infectious diseases of the skin and can be a valuable resource when it comes to the treatment of impetigo—especially in more severe cases.
“Impetigo is often diagnosed by the appearance of the rash alone," says Jozef Lazar, MD, a board-certified dermatologist in Minnesota. "Impetigo has what is described as ‘honey-colored crusting’... Occasionally a culture may be necessary, which would be performed with a Q-tip-like swab in a clinic. This would allow the doctor to see the type of bacteria growing on the skin and which antibiotics they are susceptible to.”
This type of skin swab will help determine the type of impetigo (bullous, nonbullous, or ecthyma) and if the infection is caused by Methicillin-resistant Staphylococcus aureus (MRSA).
Nonbullous impetigo is the most common form of the infection, and it is also the most contagious. It is marked by the appearance of red, small blisters that burst with fluid and leave behind a crusty appearance. Bullous impetigo results in the formation of large blisters called bullae, that appear fluid-filled and may take longer to rupture.
Ecthyma impetigo has the same crusted sores of nonbullous impetigo, but it causes ulcers to form beneath the sores and penetrate deeper into the skin, causing erosion of the dermis.
Impetigo can also be caused by an MRSA infection, which will be more difficult to treat since this particular strain of bacteria is resistant to many traditional antibacterial medications that treat impetigo.
Because of the many different types of impetigo skin infections, you should ask your doctor which type you have and how it impacts treatment options.
Impetigo treatment options
Fortunately for people with impetigo, this condition is highly curable with the help of antibacterials. For the treatment of impetigo, it’s most likely that a doctor will prescribe an antibiotic ointment or cream that will be applied directly to the infected area and clear up the skin in a matter of days. In more severe cases, an oral antibiotic may be necessary.
Impetigo medications
Generic antibiotics
There are many different types of antibiotic treatments, including antibacterials. Antibacterials are limited in the range of pathogens that they can affect since this kind of drug can only kill bacteria. Altabax (retapamulin) is an antibacterial topical that may be prescribed for impetigo treatment, and it has mild side effects like redness, irritation, and itching.
Generic antibiotic ointment can prevent the spread of bacteria and kill existing pathogens, and reach beyond the scope of antibacterials to kill certain types of fungi and parasites as well. In the case of impetigo, this doesn’t necessarily affect treatment, as both an antibacterial or antibiotic topical will help treat the condition. Although side effects may differ slightly, as antibiotics tend to be stronger and may cause more itching or discomfort in the applied area. Some medications that fall into this category are Bactroban and Centany (mupirocin).
However, none of the previously mentioned antibiotics will do much good if the skin infection is caused by MRSA, as it is resistant to most antibacterials. In this case, the first line of defense is to prescribe different drugs like Bactrim (trimethoprim/sulfamethoxazole), which is a conjunction of two different types of antibiotics that each work to kill the resistant bacteria strain and stop it from spreading. Based on the severity of the infection, your doctor may have to use multiple broad-spectrum antibiotics.
Penicillin-like antibiotics
This class of antibiotics is derived from a fungus called Penicillium, and drugs that fall into this subcategory of antibiotics are some of the most commonly prescribed antibiotics. Amoxicillin and Augmentin are two types of penicillin-like antibiotics that are quite similar since Augmentin contains Amoxicillin in addition to Clavulanate, which is an ingredient that increases the potency of the medication. Some common side effects of these drugs include skin itchiness and irritation when applied topically, as well as headaches, nausea, and diarrhea when taken orally. However, these are commonly used antibiotics and are generally very safe. Amoxicillin is less effective of the two, as bacteria develop more antibiotic resistance.
Cephalosporin antibiotics
Cephalosporins are similar to penicillins and directly kill a wide range of bacteria. This broad-spectrum group of antibiotics is derived from Acremonium (a type of mold that has previously been referred to as Cephalosporium). These medications prevent bacteria from building their cell walls, effectively treating the infection. Keflex (cephalexin) and Duricef (cefadroxil) are cephalosporin antibiotics that are taken orally and may produce side effects like diarrhea, headache, or joint pain.
Lincomycin antibiotics
For patients who are allergic to penicillin, lincomycin antibiotics are often used to treat bacterial infections. These narrow-spectrum antibiotics help kill pathogenic species of Streptococcus pyogenes and Staphylococcus aureus, the two types of bacteria that are most often responsible for causing impetigo. A common lincomycin antibiotic prescribed for impetigo treatment is Cleocin (clindamycin), although, it does have some potential side effects that may include hives, rash, redness, or peeling skin.
What is the best medication for impetigo?
The best medication for impetigo will depend on what kind of bacterial strain has caused the infection. Before prescribing a medication, a doctor will also take into account the patient’s medical history and other medications in order to determine which antibiotic will have the best treatment response.
Here are a few of the most commonly prescribed medications for impetigo:
| Drug name | Drug class | Administration route | Standard dosage | Common side effects |
| Centany (mupirocin) | Antibiotic | Topical | A small amount of ointment should be applied to the affected area three times daily | Skin, eye, nose irritation |
| Keflex (cephalexin) | Cephalosporin antibiotic | Oral | 25 to 50 mg/kg given in equally divided doses | Diarrhea, headache, dizziness |
| Amoxil Biomox Polymox (amoxicillin) | Penicillin-like antibiotic | Oral | One 500 mg tablet taken every 12 hours | Nausea, vomiting, diarrhea |
| Altabax (retapamulin) | Antibacterial | Topical | A thin layer should be applied to the affected area twice daily | Application site irritation, headache, dry skin |
| Bactrim (sulfamethoxazole-trimethoprim) | Antibiotic | Oral | One regular strength tablet is taken every 12 hours | Abdominal pain, diarrhea, skin blisters |
| Cleocin (clindamycin) | Lincomycin antibiotic | Oral solution | 4–6 mg/lb/day divided into 3 or 4 equal doses | Diarrhea, nausea, vomiting |
Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of impetigo medication?
When it comes to topical antibiotics, the most common side effects include:
- Itching
- Redness
- Dry skin
- Tenderness
- Swelling
When taking an oral antibiotic, other side effects exist, such as:
- Diarrhea
- Nausea
- Headache
- Vomiting
- Abdominal pain
Please keep in mind that this is not a full list of side effects, and you should always talk to your doctor or dermatologist for a complete list of possible adverse events and drug interactions for impetigo treatment.
What are the best home remedies for impetigo?
Impetigo is likely to require prescription medications like topical antibacterials in order to be sufficiently cured, although there are some natural remedies that people have used to help treat or prevent the infection, including:
- Studies have shown that manuka honey has antimicrobial properties, so it may help kill the bacteria that cause impetigo. For this at-home remedy, apply a small amount of honey directly to the parts of the body with impetigo sores. Let the honey sit for 20 minutes, then rinse it off with warm water.
- “Bleach baths are a great way to prevent impetigo,” according to Susan Bard, MD, a board-certified dermatologist in Brooklyn, New York.
- Wash sheets and pillowcases after being diagnosed with impetigo and continue to do this regularly to prevent infections in the future.
- Since impetigo is highly contagious and can be spread through close contact, it is important to resist touching the infected area unless washing the skin.
- To help prevent the spread of the bacterial infection, gently wash the skin with warm water and an antibacterial soap (preferably one without fragrance or other potential skin irritants). Use a new towel to dry the area after each wash to guard against reinfection. This cleansing can be performed several times a day.
- Try to avoid putting a bandage over the impetigo sores.
Frequently asked questions about impetigo
What is the best treatment for impetigo?
The best treatment for impetigo is through prescription antibiotics that effectively kill the bacteria that causes impetigo and prevents the infection from spreading.
How do you treat impetigo at home?
Some natural remedies like manuka honey and bleach baths may help treat impetigo, however, it is most effective to use a prescription antibiotic.
How long does it take for impetigo to go away?
With the proper treatment, impetigo can go away within a week and may last up to 10 days.
Can impetigo go away on its own?
It is possible for impetigo to go away on its own, although this can take a few weeks and may cause the infection to spread if the proper precautions are not taken. If you have diabetes, then you should seek immediate medical help to prevent worsening of the infection.
What are some good over-the-counter treatments for impetigo?
Over-the-counter antibiotic cream or ointment that contains bacitracin may improve minor infections, but generally, there is no OTC treatment for impetigo.