Highlights & Basics
- Impetigo is a highly contagious and common bacterial infection of the skin that typically occurs in children; a key consideration for schools and playgroups.
- Typically staphylococcal or streptococcal. Diagnosis is usually clinical; bacterial skin cultures are reserved for extensive disease or where there is risk of spread of infection.
- Skin that has been broken by minor trauma or other disease is particularly susceptible to infection.
- Tends to resolve spontaneously or with topical antiseptics.
- Topical antibiotics are effective, but resistance may be an issue in some regions.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Citations
Hartman-Adams H, Banvard C, Juckett G. Impetigo: diagnosis and treatment. Am Fam Physician. 2014 Aug 15;90(4):229-35.[Abstract][Full Text]
Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.[Abstract][Full Text]
Koning S, van der Sande R, Verhagen AP, et al. Interventions for impetigo. Cochrane Database Syst Rev. 2012 Jan 18;(1):CD003261.[Abstract][Full Text]
1. Hartman-Adams H, Banvard C, Juckett G. Impetigo: diagnosis and treatment. Am Fam Physician. 2014 Aug 15;90(4):229-35.[Abstract][Full Text]
2. Bowen AC, Mahé A, Hay RJ, et al. The global epidemiology of impetigo: a systematic review of the population prevalence of impetigo and pyoderma. PLoS One. 2015 Aug 28;10(8):e0136789.[Abstract][Full Text]
3. Barbieri E, Porcu G, Dona' D, et al. Non-bullous impetigo: incidence, prevalence, and treatment in the pediatric primary care setting in Italy. Front Pediatr. 2022;10:753694.[Abstract][Full Text]
4. Prindaville B, Simon SD, Horii KA. Dermatology-related outpatient visits by children: implications for workforce and pediatric education. J Am Acad Dermatol. 2016 Jul;75(1):228-9.[Abstract][Full Text]
5. Dollani LC, Marathe KS. Impetigo/Staphylococcal scalded skin disease. Pediatr Rev. 2020 Apr;41(4):210-12.[Abstract][Full Text]
6. Ho T, Taylor MT, Marathe KS, et al. Most common pediatric skin conditions managed in outpatient dermatology clinics in the United States stratified by race and ethnicity. Pediatr Dermatol. 2021 Nov;38 Suppl 2:129-31.[Abstract][Full Text]
7. Elliot AJ, Cross KW, Smith GE, et al. The association between impetigo, insect bites and air temperature: a retrospective 5-year study (1999-2003) using morbidity data collected from a sentinel general practice network database. Fam Pract. 2006 Oct;23(5):490-6.[Abstract][Full Text]
8. De Rose DU, Pugnaloni F, Martini L, et al. Staphylococcal infections and neonatal skin: data from literature and suggestions for the clinical management from four challenging patients. Antibiotics (Basel). 2023 Mar 23;12(4).[Abstract][Full Text]
9. Kakar N, Kumar V, Mehta G, et al. Clinico-bacteriological study of pyodermas in children. J Dermatol. 1999 May;26(5):288-93.[Abstract]
10. Tewodros W, Muhe L, Daniel E, et al. A one-year study of streptococcal infections and their complications among Ethiopian children. Epidemiol Infect. 1992 Oct;109(2):211-25.[Abstract]
11. Loffeld A, Davies P, Lewis A, et al. Seasonal occurrence of impetigo: a retrospective 8-year review (1996-2003). Clin Exp Dermatol. 2005 Sep;30(5):512-4.[Abstract]
12. Kristensen JK. Scabies and pyoderma in Lilongwe, Malawi. Prevalence and seasonal fluctuation. Int J Dermatol. 1991 Oct;30(10):699-702.[Abstract]
13. Centers for Disease Control and Prevention. Group A Streptococcal (GAS) disease: impetigo. Jun 2022 [internet publication].[Full Text]
14. Durupt F, Mayor L, Bes M, et al. Prevalence of Staphylococcus aureus toxins and nasal carriage in furuncles and impetigo. Br J Dermatol. 2007 Dec;157(6):1161-7.[Abstract]
15. Shi D, Higuchi W, Takano T, et al. Bullous impetigo in children infected with methicillin-resistant Staphylococcus aureus alone or in combination with methicillin-susceptible S. aureus: analysis of genetic characteristics, including assessment of exfoliative toxin gene carriage. J Clin Microbiol. 2011 May;49(5):1972-4.[Abstract]
16. Amagai M, Matsuyoshi N, Wang ZH, et al. Toxin in bullous impetigo and staphylococcal scalded-skin syndrome targets desmoglein 1. Nat Med. 2000 Nov;6(11):1275-7.[Abstract]
17. Hanakawa Y, Schechter NM, Lin C, et al. Molecular mechanisms of blister formation in bullous impetigo and staphylococcal scalded skin syndrome. J Clin Invest. 2002 Jul;110(1):53-60.[Abstract][Full Text]
18. Weedon D. Weedon's skin pathology. 3rd ed. Oxford, UK: Churchill Livingstone, Elsevier; 2009:549.
19. Jefferson T, Dooley L, Ferroni E, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2023 Jan 30;1(1):CD006207.[Abstract][Full Text]
20. Luby SP, Agboatwalla M, Feikin DR, et al. Effect of handwashing on child health: a randomised controlled trial. Lancet. 2005 Jul 16-22;366(9481):225-33.[Abstract]
21. Scully BE, Briones F, Gu JW, et al. Mupirocin treatment of nasal staphylococcal colonization. Arch Intern Med. 1992 Feb;152(2):353-6.[Abstract]
22. Raz R, Miron D, Colodner R, et al. A 1-year trial of nasal mupirocin in the prevention of recurrent staphylococcal nasal colonization and skin infection. Arch Intern Med. 1996 May 27;156(10):1109-12.[Abstract]
23. Darmstadt GL, Osendarp SJ, Ahmed S, et al. Effect of antenatal zinc supplementation on impetigo in infants in Bangladesh. Pediatr Infect Dis J. 2012 Apr;31(4):407-9.[Abstract]
24. National Institute for Health and Care Excellence. Impetigo: antimicrobial prescribing. Feb 2020 [internet publication].[Full Text]
25. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.[Abstract][Full Text]
26. Royal Children's Hospital Melbourne. Cellulitis and other bacterial skin infections. Mar 2020 [internet publication].[Full Text]
27. Hoffmann TC, Peiris R, Glasziou P, et al. Natural history of non-bullous impetigo: a systematic review of time to resolution or improvement without antibiotic treatment. Br J Gen Pract. 2021;71(704):e237-42.[Abstract][Full Text]
28. Koning S, van der Sande R, Verhagen AP, et al. Interventions for impetigo. Cochrane Database Syst Rev. 2012 Jan 18;(1):CD003261.[Abstract][Full Text]
29. Kwak YG, Choi SH, Kim T, et al. Clinical guidelines for the antibiotic treatment for community-acquired skin and soft tissue infection. Infect Chemother. 2017 Dec;49(4):301-25.[Abstract][Full Text]
30. Wallin TR, Hern HG, Frazee BW. Community-associated methicillin-resistant Staphylococcus aureus. Emerg Med Clin North Am. 2008 May;26(2):431-55.[Abstract]
31. Vogel A, Lennon D, Best E, et al. Where to from here? The treatment of impetigo in children as resistance to fusidic acid emerges. N Z Med J. 2016 Oct 14;129(1443):77-83.[Abstract]
32. Gropper S, Albareda N, Chelius K, et al; Ozenoxacin in Impetigo Trial Investigators Group. Ozenoxacin 1% cream in the treatment of impetigo: a multicenter, randomized, placebo- and retapamulin-controlled clinical trial. Future Microbiol. 2014;9(9):1013-23.[Abstract]
33. Rosen T, Albareda N, Rosenberg N, et al. Efficacy and safety of ozenoxacin cream for treatment of adult and pediatric patients with impetigo: a randomized clinical trial. JAMA Dermatol. 2018 Jul 1;154(7):806-13.[Abstract]
34. Bowen AC, Tong SY, Andrews RM, et al. Short-course oral co-trimoxazole versus intramuscular benzathine benzylpenicillin for impetigo in a highly endemic region: an open-label, randomised, controlled, non-inferiority trial. Lancet. 2014 Dec 13;384(9960):2132-40.[Abstract]
35. Sartelli M, Coccolini F, Kluger Y, et al. WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections. World J Emerg Surg. 2022 Jan 15;17(1):3.[Abstract][Full Text]
36. The Primary Care Dermatology Society. Impetigo. May 2022 [internet publication].[Full Text]
37. Galindo E, Hebert AA. A comparative review of current topical antibiotics for impetigo. Expert Opin Drug Saf. 2021 Jun;20(6):677-83.[Abstract][Full Text]
38. Abbas M, Paul M, Huttner A. New and improved? A review of novel antibiotics for Gram-positive bacteria. Clin Microbiol Infect. 2017 Oct;23(10):697-703.[Abstract]
39. Bassetti M, Della Siega P, Pecori D, et al. Delafloxacin for the treatment of respiratory and skin infections. Expert Opin Investig Drugs. 2015 Mar;24(3):433-42.[Abstract]
40. Chamny S, Miron D, Lumelsky N, et al. Topical minocycline foam for the treatment of impetigo in children: results of a randomized, double-blind, phase 2 study. J Drugs Dermatol. 2016 Oct 1;15(10):1238-43.[Abstract]
41. UK Health Security Agency. Children and young people settings: tools and resources. Oct 2023 [internet publication].[Full Text]
