Impetigo - School Sores


What is impetigo?

It is a localised infection caused by a bacteria. The bacteria may be Staphylococcus aureus or a Group A beta-hemolytic Streptococcus or a combination of both. Both of these bacteria are found on the skin in normal circumstances. However, when the skin barrier is broken, they can also cause infection.

The infection usually occurs around the mouth, in the neck area or on the hands.

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Who gets it?

It occurs in infants and young children. Children who have eczema, who are likely to have inflamed skin and a reduced skin barrier, are more likely to suffer from this infection. It is sometimes called "school sores".

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What do school sores look like?

First the skin becomes red and then blisters appear. These break and then crusts (scabs) appear and these have a yellowish golden color. The picture on the right is characteristic.

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Is it contagious?

Yes. It is very contagious. Children touch the scabs and then can pass the infection on.

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How long should I keep my child away from other children?

Until all the skin rash has dried up.

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How do I prevent school sores?

The most important thing is hand-washing with soap (normal or anti-bacterial). It has been shown that hand-washing reduces the risk of school sores as well as the risk of other infections like pneumonia and gastroenteritis.

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How do I treat impetigo?

There are several treatments. Initially, if the infection is not severe, topical treatment (cream or ointment) can be used. If the infection is moderate or severe, antibiotics will needed orally (by mouth).

Treatment is required for at least a week.

Topical treatments (creams, ointments, oils) include:

  • Tea tree oil- a natural product from the Australian (or New Zealand) tea tree
  • Tea ointment or liquor - crude tea has been shown to be effective
  • Hydorgen peroxide (Microcid)
  • Fusidic acid (Fucidin) - an antibiotic
  • Mupirocin (Bactroban) - another antibiotic that is as effective as oral Erythromycin. In some centers, this antibiotic ointment is limited in use so bacteria don't get resistant to it which would then limit its usefulness in MRSA infections. I suggest you try simpler measures and keep this antibiotic for infections with MRSA (meticillin resistant Staph aureus).

Oral treatments should be used for any infection more than mild. These include:

  • Co-amoxiclav (Augmentin) - an antibiotic combination of Amoxicillin and Clavulanate. Don't take this is there is an allergy to penicillin
  • Erythromycin - an antibiotic. You can take this if you are allergic to Penicillin

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  • Rice TD, Duggan AK, DeAngelis C. Cost-effectiveness of erythromycin versus mupirocin for the treatment of impetigo in children. Pediatrics. 1992 Feb;89(2):210-4.
  • Barton LL, Friedman AD, Sharkey AM, Schneller DJ, Swierkosz EM.Impetigo contagiosa III. Comparative efficacy of oral erythromycin and topical mupirocin. Pediatr Dermatol. 1989 Jun;6(2):134-8.
  • Christensen OB, Anehus S. Hydrogen peroxide cream: an alternative to topical antibiotics in the treatment of impetigo contagiosa. Acta Derm Venereol. 1994 Nov;74(6):460-2.
  • Luby SP, Agboatwalla M, Feikin DR, Painter J, Billhimer W, Altaf A, Hoekstra RM. Effect of handwashing on child health: a randomised controlled trial.Lancet. 2005 Jul 16-22;366(9481):225-33.
  • Martin KW, Ernst E.Herbal medicines for treatment of bacterial infections: a review of controlled clinical trials. J Antimicrob Chemother. 2003 Feb;51(2):241-6. Links
  • Sharquie KE, al-Turfi IA, al-Salloum SM.The antibacterial activity of tea in vitro and in vivo (in patients with impetigo contagiosa). J Dermatol. 2000 Nov;27(11):706-10.

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Last reviewed 16 May 2011

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Dr Maud MD

Dr Maud MD (MBChB, FRACP, FRCPCH), a specialist pediatrician, provides health information and medical advice for parents of babies and toddlers. Read more about Dr Maud.

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