Impetigo – Specialist Diagnosis & Treatment for Bacterial Skin Infections in London

What is impetigo?

Impetigo is a contagious bacterial skin infection that affects the outermost layers of the skin. It spreads easily through direct contact with lesions, shared towels, or close contact sports. There are two main clinical types: non‑bullous impetigo (the commonest form with honey‑coloured crusts) and bullous impetigo (larger, flaccid blisters caused by toxin‑producing staphylococci).

Causes and how it develops

Impetigo occurs when bacteria enter through minor breaks in the skin, such as insect bites, scratches, or eczema. Non‑bullous disease typically involves Staphylococcus aureus and/or Streptococcus pyogenes. Crowded environments, warm humid weather, and close skin‑to‑skin contact increase transmission.

Impetigo Symptoms and patterns

Lesions often begin as small red papules that quickly form blisters, which rupture and leave characteristic golden crusts. They commonly appear around the nose and mouth but may affect any exposed area, especially hands and forearms. Itching is common and scratching can auto‑inoculate new sites.

Impetigo Diagnosis and tests

Diagnosis is clinical based on the classic appearance. Swabs for bacterial culture may be taken during outbreaks, if MRSA is suspected, or when standard treatment fails. We also consider eczema, cold sores, fungal infections, and scabies in the differential diagnosis.

Impetigo Treatment options and management

Medical treatments

Topical antibiotics are first‑line for limited disease. Oral antibiotics are used for extensive lesions, clusters, bullous impetigo, or systemic symptoms. Pain/itch relief and wound care support comfort.

Hygiene and prevention

Clean crusts gently with warm water, avoid picking, keep nails short, and cover lesions where practical. Do not share towels, face cloths, razors, or cosmetics. Wash hands frequently and launder clothing and bedding on hot cycles. Children can usually return to school 24 hours after starting antibiotics if lesions are covered.

When urgent review is needed

Seek urgent assessment for spreading redness with fever, rapidly worsening pain, lethargy in children, or involvement of fragile skin (e.g., newborns) as these may indicate complications.

Why choose Skinhorizon for impetigo?

• Consultant dermatologist‑led diagnosis and management to clear infection quickly and reduce spread.
• Evidence‑based antibiotic choice with antimicrobial stewardship and safety advice.
• Clear prevention guidance for families, schools, and teams under CQC standards.

Your first visit — what to expect

1. History: Onset, contacts, outbreaks at school/work, underlying skin disease (e.g., eczema), and previous treatments.
2. Examination: Lesion distribution and type (non‑bullous/bullous), signs of cellulitis or systemic illness.
3. Discussion: Education on contagion, hygiene, school/work guidance, and expected response (usually within 48–72 hours).
4. Treatment plan: Topical or oral antibiotics, skin‑care measures, and itch/pain relief.
5. Follow‑up: Review if not improving, culture if recurrent, and advice to prevent reinfection.

Reviewed by: Dr Mohammad Ghazavi, Consultant Dermatologist
Skinhorizon Clinic, 4 Clarendon Terrace, Maida Vale, London W9 1BZ
Last reviewed: 21 August 2025