Impetigo: What It Looks Like and How to Treat It

Impetigo pictures can give you a fairly good idea of what this condition looks like.

Impetigo is a highly contagious bacterial skin infection that causes sores and a honey-colored crust or blister-like bumps. It can be itchy and painful, and it occurs when skin—especially already irritated or broken skin—comes in contact with a common type of staph or the bacteria responsible for strep throat.

This article describes the types of impetigo and shares pictures of impetigo to help illustrate the symptoms. It also discusses similar conditions, causes, and risks factors. You'll learn how impetigo is diagnosed, treated, and prevented, plus what to expect if a child has it or you do.

This photo contains content that some people may find graphic or disturbing.

Impetigo on a child's arm
Impetigo on a child's arm. Matthew Roberge / Getty Images

Types of Impetigo

Impetigo can happen to anyone, but it typically affects infants and children and is most common in those ages 2 to 5 years. It is classified based on the appearance of the infected skin and how deep the infection goes into skin layers.

The two main types of impetigo are non-bullous impetigo and bullous impetigo. Non-bullous is the most common type and is characterized by discoloration, such as redness, on the surrounding skin.

If untreated, impetigo can develop into ecthyma. Ecthyma is a serious infection that goes deeper into the skin than the other two types.

Symptoms and Pictures of Impetigo

Impetigo is generally a mild infection most common in young children. Common areas where it begins are on exposed skin, such as around the nose and mouth or on the arms and legs.

Untreated infections can quickly spread to other areas on the child's body. Pain and itchiness may occur in all types of impetigo, and scratching can further spread the infection.

2:13

Click Play to Learn All About Impetigo

This video has been medically reviewed by Casey Gallagher, MD

Non-Bullous Impetigo (Impetigo Contagiosa)

The most common form of impetigo, it involves only the outermost layers of skin called the epidermis. It often occurs in areas where the skin has been broken, irritated, or damaged.

The nostrils, especially in kids with runny noses, are commonly affected. The face, the neck, and the hands are other areas of the body where you are likely to see lesions.

This photo contains content that some people may find graphic or disturbing.

5 year old child with Impetigo (nonbullous impetigo) witch is is a bacterial infection that involves the superficial skin. Yellow scabs on infected area.

Helin Loik-Tomson / Getty Images

Key features:

  • It begins as red, itchy sores that drain clear fluid or pus for a few days.
  • Honey-colored, crusted lesions then develop over the sores.

Bullous Impetigo

Bullous impetigo also affects the epidermis. It tends to form in areas where skin folds or rubs against other skin, including the arms, legs, trunk, buttocks, armpits, and groin.

This photo contains content that some people may find graphic or disturbing.

A person with bullous impetigo on their back

Reproduced with permission from © DermNet dermnetnz.org 2023.

Key features:

  • It begins with fluid-filled blisters.
  • Lesions are much larger and may stay intact on the skin longer before rupturing.
  • Lesions may ooze a yellow fluid.
  • Surrounding skin is not discolored.

Ecthyma (Deep Impetigo)

This is a more serious bacterial infection that goes into the deeper skin layer of the dermis.

This photo contains content that some people may find graphic or disturbing.

A person with ecthyma (deep impetigo)

Reproduced with permission from © DermNet and © Te Whatu Ora Waikato www.dermnetnz.org 2023.

Key features:

  • It begins as a pustule; blisters are painful.
  • Blisters turn into deep punched-out ulcers; a brown-black crust may also form.

When to See a Healthcare Provider

If you notice any itchy or painful red bumps, a honey-colored crust over sores, or blister-looking bumps on your child's skin, call the pediatrician immediately so that the infection can be treated and to prevent it from spreading elsewhere on the child or to others.

If you child has a fever, swollen glands, blood in their urine, or no energy, seek urgent medical attention.

Other Conditions That Look Like Impetigo

Multiple other blistering and rash disorders can look like impetigo. Ones that may look like non-bullous impetigo include:

  • Atopic dermatitis
  • Bockhart impetigo (not true impetigo)
  • Childhood discoid lupus erythematosus
  • Contact dermatitis
  • Cutaneous candidiasis
  • Dermatophytosis (tinea corporis or capitis)
  • Herpes simplex virus
  • Pediculosis (lice)
  • Scabies
  • Sweet syndrome (acute febrile neutrophilic dermatosis)
  • Varicella zoster virus

To make sure it's not bullous impetigo, healthcare providers will want to rule out these similar conditions:

  • Bullous erythema multiforme
  • Bullous fixed drug eruption
  • Bullous lupus erythematosus
  • Bullous pemphigoid reactions
  • Bullous scabies
  • Contact dermatitis
  • Dermatitis herpetiformis
  • Insect bites
  • Linear immunoglobulin A bullous dermatitis
  • Necrotizing fasciitis
  • Pemphigus vulgaris
  • Stevens-Johns syndrome
  • Thermal burns
  • Transient neonatal pustular melanosis

Causes of Impetigo

Impetigo can occur when skin is exposed to either:

  • Staphylococcus aureus, a type of staph responsible for a variety of types of skin infections and other concerns
  • Group A Streptococcus (GAS or Group A strep, also known as Streptococcus pyogenes), also responsible for strep throat, cellulitis, and other infections

The likely culprit(s) of a case of impetigo ultimately depends on the type that occurs.

Impetigo Type Caused by S. aureus Caused by Group A strep
Non-bullous
Bullous
Ecthyma

Ecthyma can occur from untreated impetigo that develops into a deeper infection.

Impetigo can develop as a primary infection when the bacteria infects normal skin, or it can form as a secondary infection when bacteria invades already irritated or open skin, such as from a wound, insect bite, poison ivy, eczema, herpes, or scabies.

Direct contact with infected lesions is what causes spread. This can occur in a number of ways and settings, such as:

  • When a child scratches an infected area and then touches another part of their body
  • Hugs, hand-shaking, or other forms of direct contact with an infected individual
  • Engaging in certain sports, such as wrestling
  • Crowded areas, such as schools or daycare centers

The S. aureus bacteria commonly colonize (live on) the skin of children and adults. They are especially commonly found in the nose and can be passed easily if children pick their noses.

Though technically one step removed from direct contact, the infection can also spread if you touch the clothes, towels, or sheets of an infected person.

Who's At Risk for Impetigo?

Anyone can get impetigo, but some people are more at risk than others.

These factors can increase the risk of impetigo:

  • Age: Impetigo most commonly affects children aged 2 to 5 years.
  • Infections or injuries that break the skin: People with scabies infections and people participating in activities where cuts or scrapes are common are at higher risk.
  • Group settings: Having close contact with other people is the most common risk factor. Close contact can occur in the home, in large gatherings, or at schools, daycare centers, and military training facilities.
  • Climate: Impetigo can occur anywhere, but is more commonly seen in areas with hot, humid summers and mild winters (subtropics) and those with wet and dry seasons (tropics).
  • Poor personal hygiene: A lack of proper handwashing, body washing, and facial cleanliness can lead to impetigo.

How Impetigo Is Diagnosed

Diagnosis of impetigo is usually made after a practitioner examines the skin and notices the typical appearance of the infection.

A healthcare provider may also want to do a bacterial culture. This may be the case if the provider suspects impetigo is being caused by a resistant bacteria, such as MRSA (methicillin-resistant staphylococcus aureus), or if a rash is not going away.

Treatment for Impetigo

For small areas of infection, an over-the-counter or prescription-strength topical antibiotic is typically all that is needed. You will also need to regularly wash the area with warm, soapy water and then cover it with a bandage to prevent spread to others.

This photo contains content that some people may find graphic or disturbing.

Antibiotic application on an impetigo wound.

Siro Rodenas Cortes / Getty Images

Those diagnosed with impetigo may be treated with topical antibiotics or oral antibiotics to avoid complications and prevent its spread. Topical antibiotics are applied to the skin, while oral antibiotics are taken by mouth.

Treatment options for topical antibiotics include:

  • Mupirocin
  • Retapamulin
  • Fusidic acid

Oral antibiotics that may be used to treat impetigo include:

  • Amoxicillin/clavulanate
  • Dicloxacillin
  • Cephalexin
  • Clindamycin
  • Doxycycline
  • Minocycline
  • Trimethoprim/sulfamethoxazole
  • Macrolides

Neosporin is generally not advised for use in the treatment of impetigo. As far as topical antibiotics go, the ingredient neomycin in Neosporin is not as effective as other options for in treating impetigo. Topical products containing fusidic acid or mupirocin work better.

For more extensive or persistent infections, an oral or intravenous antibiotic might be needed. Ecthyma is typically treated with oral antibiotics, for example.

MRSA is resistant to some antibiotics that are commonly used to treat impetigo, including macrolides and mupirocin.

If MRSA is suspected, antibiotic treatment options include trimethoprim/sulfamethoxazole, clindamycin, or a tetracycline (doxycycline or minocycline).

Once treatment starts, the infection should begin to disappear within a few days. If you aren't noticing a change, let your healthcare provider know since a different medication may be needed.

Repeat Infections

It is possible to get impetigo more than once. If impetigo or other staph-related skin infections continue to occur, your practitioner may recommend that all members of your household get treated with antibiotics, such as Bactroban (mupirocin) nasal gel twice a day for five to seven days.

Other measures, such as baths with Hibiclens (an antiseptic, antimicrobial skin cleanser) and very frequent hand washing, may also be recommended.

How Long Is Impetigo Contagious?

Children are usually no longer contagious once they have been on antibiotics for 24 to 48 hours, there is no longer any discharge from lesions, and you are seeing signs of improvement.

Prognosis for Impetigo

Impetigo can heal on its own, even without treatment. When it does heal by itself, it should go away in about seven to 10 days.

Most cases of impetigo resolve without complications or scarring. If a scar does occur, it is typically from a deep infection of ecthyma. In these cases, you may want to see a dermatologist who can offer treatments to minimize the appearance of the scar.

In extremely rare cases, impetigo can lead to serious complications if it goes untreated. These can include:

  • Post-streptococcal glomerulonephritis, inflammation of the filters of the kidneys that can develop after a Group A strep infection. This can lead to hematuria (bloody urine) and high blood pressure.
  • Scarlet fever, a condition caused by Group A strep that is characterized by fever, rash, and a red tongue
  • Septicemia, a serious blood infection caused by bacteria

How to Prevent Impetigo

Impetigo is a disease you can get more than once. Having it once doesn't protect you from getting it again, and you can't get a vaccine for impetigo caused by group A staph infections.

By following these prevention tips, you can help protect yourself and others:

  • Clean and care for wounds.
  • Wash your hands often.
  • Do laundry often.
  • Take antibiotics, if prescribed.

Make sure children follow good hand hygiene, and if they have any bites, scrapes, or rashes, keep a close eye on the injuries and keep them clean and covered.

Summary

Impetigo is a highly contagious bacterial infection. It most commonly affects children aged two to five years, but can affect anyone. Of the two main types, non-bullous impetigo is more common than bullous impetigo. If left untreated, impetigo can develop into a serious infection called ecthyma.

Impetigo pictures show what this infection looks like. Symptoms include discolored, itchy sores with crusted lesions; large, fluid-filled blisters; and deep ulcers.

See a healthcare provider if you suspect impetigo or another skin condition. If diagnosed, impetigo can be treated with antibiotics. Prevent impetigo by washing hands and laundry often and keeping wounds clean.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Impetigo: all you need to know.

  2. American Academy of Dermatology Association. Impetigo: signs and symptoms.

  3. Hartman-Adams H, Banvard C, Juckett G. Impetigo: diagnosis and treatment. Am Fam Physician. 2014;90(4):229-35.

  4. Wound Management & Prevention. Neonates and topical antimicrobials: what should we be using?

  5. Creech CB, Al-Zubeidi DN, Fritz SA. Prevention of recurrent staphylococcal skin infectionsInfect Dis Clin North Am. 2015;29(3):429–464. doi:10.1016/j.idc.2015.05.007

  6. American Academy of Dermatology Association. Impetigo: diagnosis and treatment.

  7. Galli L, Novelli A, Ruggiero G, Stefani S, Fortina AB. Pediatric impetigo: an expert panel opinion about its main controversies. J Chemother. 2022;34(5):279-285. doi:10.1080/1120009X.2021.1961185

  8. National Institute of Diabetes and Digestive and Kidney Diseases. Glomerular diseases.

By Vincent Iannelli, MD
 Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.