Very contagious, common in children, and clears quickly once treated.
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Impetigo is a bacterial skin infection, mostly affecting children, and it is very contagious — which is the main reason it matters. It produces sores that burst and dry into a characteristic golden-yellow crust.
It is not dangerous, it clears with treatment, and it is not a sign of a dirty house — something worth saying, because parents are often quietly mortified by it.
Three practical points:
More common in babies and younger children. Larger fluid-filled blisters, often on the trunk, arms or in skin folds. They are more fragile, leave a wider raw area when they break, and children with this form are more likely to have a fever and feel unwell.
The redness is much harder to see. Look for the crusting and the moist raw base rather than the colour — impetigo is more often missed or diagnosed late on brown and black skin for exactly this reason.
Staphylococcus aureus, and sometimes Streptococcus pyogenes. Both live harmlessly on skin and in the nose in many people — they cause trouble when they get through a break in the skin.
This is the part most often skipped:
Recurrent impetigo also raises the question of nasal carriage — some people carry staphylococcus in their nostrils and reseed themselves. It can be treated, and it is worth asking about after a second or third episode.
Poor hygiene, in the way people assume. It is very common in clean households; what matters is broken skin and close contact, not how often anyone washes.
Impetigo is diagnosed by appearance, and a clear, well-lit photograph is usually all that is needed — which makes it well suited to a remote consultation, and spares a trip out with a contagious child.
Hydrogen peroxide 1% cream is now first-line for localised non-bullous impetigo. It works as well as a topical antibiotic for limited disease, and it does not contribute to resistance.
This is a deliberate change in national guidance rather than a lesser option — worth explaining, because people often expect an antibiotic and read anything else as being fobbed off.
Fusidic acid cream, for localised impetigo where antiseptic is unsuitable or has not worked. Short courses only — five days — because prolonged use drives resistance, which is a real and growing problem with this particular antibiotic.
This is the step that decides whether you are back in a month. Treat the eczema properly. Check for and treat scabies or head lice. Manage cold sores. Impetigo landing repeatedly on the same child almost always has a reason.
Where episodes keep recurring, we consider nasal staphylococcal carriage and can treat it, along with a household decolonisation approach where appropriate.
Seek urgent medical attention for:
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Children can go back 48 hours after starting antibiotic treatment, or once all the sores have crusted over and dried — whichever happens first. There is no need to keep a child off beyond that, and a great many unnecessary days are lost to not knowing it.
Cover the sores where practical while they are healing.
Worth stating plainly, because it comes up every time: impetigo is not a sign of a dirty child or a dirty home. It is a common bacterial infection that gets in through broken skin, and it happens in scrupulously clean households constantly.
Hydrogen peroxide 1% cream is available over the counter and is recommended as first-line for localised impetigo. It costs a few pounds, it works, and it generates no antibiotic resistance — which matters, because fusidic acid resistance in the UK rose in direct proportion to how freely it was prescribed.
Pharmacy First now covers impetigo in England for people aged one and over — free, same-day, no appointment. That is the right first stop and we would direct you there.
Where a private consultation is genuinely useful is speed for a child who needs to be back at school. A same-day photo assessment resolves that, where the alternative may be days of waiting with a spreading rash and a child kept at home.
The practical points cost nothing: soak crusts off gently with warm water before applying anything, keep fingernails short, do not share towels or flannels and wash them hot, and children can usually return to school 48 hours after starting treatment or once lesions have crusted over.
What needs oral antibiotics rather than cream: impetigo over more than a small area, bullous impetigo, anyone systemically unwell, or infection in someone immunosuppressed.
NICE NG153, Impetigo: antimicrobial prescribing, is the governing guideline. It recommends hydrogen peroxide 1% cream as first-line for localised non-bullous impetigo, reserving topical antibiotics for cases unsuitable for or unresponsive to it — explicitly to reduce antimicrobial resistance.
NG153 recommends oral antibiotics — flucloxacillin, or clarithromycin in penicillin allergy — for widespread or bullous impetigo, or where someone is systemically unwell.
NICE Clinical Knowledge Summary, Impetigo, covers hygiene measures and school exclusion advice, recommending exclusion until lesions are crusted and healed or 48 hours after starting antibiotic treatment.
The NHS Pharmacy First clinical pathway for impetigo applies NG153 in community pharmacy for people aged one and over.
NG153 and antimicrobial stewardship guidance underpin the position on avoiding repeated topical antibiotic courses.
48 hours after starting antibiotic treatment, or once all the sores have dried and crusted over — whichever comes first. That is the actual rule. Keeping a child off for longer is unnecessary, and a lot of school and work is lost to uncertainty about it.
Because for a small localised patch, hydrogen peroxide 1% cream works as well as a topical antibiotic and does not drive resistance. This is current national guidance rather than a cheaper substitute. Where impetigo is widespread, blistering, or your child is unwell, antibiotics are the right answer and we will prescribe them.
No — and this comes up almost every time. Impetigo is caused by bacteria that live harmlessly on most people's skin getting in through a break: eczema, a bite, a graze, a runny nose. It is extremely common in immaculate households. It says nothing about hygiene.
Because something underneath is letting it in — and treating the impetigo alone will not stop the cycle. The usual culprits are eczema, scabies and head lice, all of which cause scratching and broken skin. Recurrent episodes also raise the possibility of nasal staphylococcal carriage, which can be treated. It is worth investigating rather than repeating courses.
No. It damages the healing skin, spreads the bacteria to new areas, and can leave marks. Soaking gently with warm water to soften them is fine; scrubbing is not. Keep nails short, since scratching is the main way it travels.
Yes, though it is much more common in children. In adults it usually follows a skin injury, eczema, shaving, or contact with an infected child. It behaves the same way and is treated the same way.
A rare complication where a streptococcal skin infection triggers inflammation in the kidneys, typically one to two weeks later. Dark or cola-coloured urine, a puffy face or reduced urine output after impetigo should be assessed promptly. It is uncommon and usually recovers, but it is worth knowing to look for.
August 23, 2026
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Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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