Impetigo in babies: the honey-crusted skin infection
Spotting crusty, golden sores around your baby's nose or mouth can feel alarming, but impetigo is one of the most common and treatable skin infections in young children. A short course of antibiotic cream is usually all it takes, and most babies are back to normal within a week or two. Here is what you need to know.
What impetigo is
Impetigo is a bacterial skin infection, nearly always caused by Staphylococcus aureus (staph) or Streptococcus pyogenes (strep), or a combination of both. It infects the outermost layer of skin, which is why it looks superficial and responds well to topical antibiotics.
There are two types. Non-bullous impetigo is by far the most common in babies. It starts as small blisters that quickly burst, leaving raw red patches which then develop the characteristic honey-coloured or golden-brown crust. Bullous impetigo produces larger, fluid-filled blisters that stay intact for longer before bursting and leaving a thinner, yellow-brown crust. Bullous impetigo is caused specifically by staph and tends to appear on the torso, arms, and nappy area.
Where it appears
In babies and young children, non-bullous impetigo most commonly appears around the nose and mouth, where skin gets damp from drool and runny noses. You may also see it around the eyes, on the hands and fingers (especially if your baby scratches other spots), and in the nappy area where the skin barrier is weaker. Impetigo can develop on any skin that has a tiny cut, graze, or insect bite giving bacteria a way in.
How contagious it is
Impetigo is very contagious. It spreads through direct skin contact with an infected person, and through touching shared objects such as towels, face cloths, clothing, and bedding. In households with young children, it is common for more than one child to pick it up. According to the NHS, your baby is contagious until all the sores have crusted over and dried, or until 48 hours after starting antibiotic treatment.
Treatment: antibiotic cream for most cases
For mild impetigo covering a small area, a GP will usually prescribe a topical antibiotic cream such as fusidic acid or mupirocin. Apply it exactly as directed, typically three times a day for five to seven days. Always complete the full course even if the skin looks better sooner. To apply the cream safely, wash your hands first, then gently clean the sore with warm water to soften and remove loose crusts before applying a thin layer of cream. Wash your hands again thoroughly afterwards.
If the impetigo is spreading, covers a large area, or your baby has a fever, a GP will likely prescribe oral antibiotics (usually flucloxacillin or amoxicillin). Oral antibiotics work faster and are better suited to widespread infection. The full course is typically seven days. NHS guidance recommends completing every dose to reduce the risk of antibiotic resistance.
Preventing spread within the family
A few practical steps make a big difference. Give your baby their own dedicated towel and face cloth and keep them separate from everyone else's. Change and wash your baby's bedding, clothing, and any soft toys they have been close to at 60°C or above to kill the bacteria. Avoid touching the sores with bare hands, and if you need to apply cream, wash your hands immediately before and after. Keep your baby's fingernails short to reduce scratching and the risk of spreading bacteria to other areas. Avoid sharing utensils or dummies with other children while the infection is active.
Nursery and childcare return
NHS guidance is clear: your baby should stay at home until either all the sores have dried and crusted over completely, or 48 hours after starting antibiotic treatment, whichever comes first. Covering the sores with a loose dressing when returning to nursery is a sensible precaution. Let the nursery know so they can keep an eye on other children.
When to see a GP
You should see a GP if you suspect impetigo, since prescription antibiotic cream is needed. Go sooner if the sores are spreading quickly despite treatment, your baby develops a fever or seems unwell, the skin around the sores becomes swollen, hot, and painful (which can signal cellulitis), your baby is under one year old, or if the infection is near the eyes.
In rare cases, strep-related impetigo can trigger a kidney condition called post-streptococcal glomerulonephritis. Signs include dark or frothy urine and swelling around the eyes or feet after the skin infection has cleared. If you notice these, contact your GP or 111 promptly.
Impetigo versus other rashes
The golden-honey crust is the clearest sign of impetigo. Eczema tends to be dry, itchy, and appears in flexural creases rather than around the mouth and nose. Cold sores (herpes simplex) appear as small tingling blisters specifically on or near the lip and do not respond to antibiotic cream. Chickenpox blisters appear all over the body including the scalp and trunk. If you are not sure, a GP can confirm the diagnosis and rule out other causes.
Frequently asked questions
How did my baby get impetigo?
Impetigo spreads through direct skin contact with an infected person or by touching contaminated objects like towels and bedding. Babies often pick it up at nursery or from a family member who has a small scratch or cut that is already infected. Skin that is broken by eczema, insect bites, or minor cuts gives the bacteria an easy entry point.
Is impetigo dangerous?
In most babies impetigo is uncomfortable but not dangerous, and it clears up quickly with treatment. Rarely, it can spread to deeper skin layers causing cellulitis, or trigger a kidney condition called post-streptococcal glomerulonephritis. Seeing a GP early and completing the antibiotic course prevents these complications.
Can I treat impetigo without seeing a doctor?
You will need a prescription for antibiotic cream, so a GP visit (in person or via a same-day call) is the first step. Some pharmacies can now assess and treat impetigo under the NHS Pharmacy First scheme in England. Do not wait and see if the sores are spreading or your baby has a fever.
When can my baby go back to nursery?
Your baby can return to nursery once all crusts have dried and fallen off, or after 48 hours of starting antibiotic treatment, whichever comes first. Keeping the area covered where possible helps reduce the risk of spreading it to other children.
Is impetigo the same as a cold sore?
No. Impetigo is caused by bacteria and responds to antibiotics. Cold sores are caused by the herpes simplex virus and require antiviral treatment, not antibiotics. Both can appear around the mouth, so if you are unsure it is worth seeing a GP to confirm which one your baby has.
How do I stop impetigo spreading at home?
Give your baby their own towel and flannel. Wash bedding, clothing, and soft toys at 60°C. Wash hands thoroughly after touching the affected area and before preparing food. Avoid squeezing or scratching the sores, and keep your baby's nails short so they cannot spread bacteria by scratching.
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