Impetigo: Symptoms, How Long It Spreads and Treatment
Medically Reviewed by Dr. Pedro Yelamo Vera, MD
Licensed Physician No. 484814280 · Official Medical College of Bizkaia (Spain)Last reviewed: 29 October 2026
Impetigo causes honey-coloured crusts, mostly in children. How it spreads, how long it is contagious, school rules and the creams used in Spain.
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Impetigo is a common bacterial skin infection. It causes red sores that burst and leave golden, honey-coloured crusts, often around the nose and mouth. It is most common in young children, but adults get it too. It is very contagious, but rarely serious. Treatment is a cream for small patches, or antibiotic tablets when it is widespread.
- Impetigo starts as red sores or blisters that burst and form crusts that look like cornflakes stuck to the skin.
- It spreads by touch and through shared towels and bedding. Children aged 2 to 5 get it most.
- The NHS says it stops being contagious 48 hours after treatment starts. Untreated, it can spread for up to three weeks.
- Small patches are treated with a cream. In Spain the usual creams are fusidic acid, mupirocin or ozenoxacin, all on prescription.
- See a doctor promptly for a baby, a fever, spreading redness or sores near the eye.
Dr. Pedro Yelamo Vera is a GP licensed in Spain (Colegiado No. 484814280).
For a medical emergency, call 112 or go to the nearest local emergency department. Do not wait for a video consultation or an online reply.
What does impetigo look like?
- It starts as red sores or small blisters. Redness can be harder to see on brown or black skin.
- The sores burst and ooze for a few days.
- They then form golden-brown, honey-coloured crusts.
- It is most common on the face, around the nose and mouth, and on the hands. It may itch.
Bullous impetigo is a less common form. It causes larger fluid-filled blisters, often on the trunk of babies and young children. The blisters leak yellow fluid and leave a scab with a scaly edge.
Cold sores, eczema and chickenpox can look similar, so a doctor checks first.
Who gets impetigo and how does it spread?
The bacteria, usually staphylococci or streptococci, get in through broken skin such as a scratch, bite or eczema. Children aged 2 to 5 get it most. Adults catch it too, often from a child at home.
It spreads by touch and through shared towels, bedding and toys. Scratching carries it to new spots.
How long is impetigo contagious?
The NHS says impetigo stops being contagious 48 hours after starting hydrogen peroxide cream or a prescribed antibiotic. Without treatment, it can stay contagious for 7 to 21 days, until all the sores have dried and crusted over.
Can my child go to school or nursery with impetigo?
Not while it is contagious. The rules differ a little by country:
- UK (NHS): stay off until 48 hours after treatment starts, or until the sores have crusted and healed.
- US (CDC): children can go back once antibiotic treatment has started and the sores are covered. Mayo Clinic says about 24 hours after starting.
- Spain: there is no single national rule. Schools and nurseries (guarderías) set their own, so ask yours.
How is impetigo treated?
The UK guideline, NICE NG153, sets the treatment by how much skin is affected:
- A few small patches, child well: NICE suggests hydrogen peroxide 1% cream first, an antiseptic. If that does not suit, a short course of an antibiotic cream.
- Widespread patches: an antibiotic cream or antibiotic tablets.
- Bullous impetigo, a child who is unwell, or high risk: antibiotic tablets.
NICE advises against using an antibiotic cream and tablets together. Your prescription and the leaflet say how to use them.
What is different in Spain?
Hydrogen peroxide cream is not among the options in the Spanish children's antibiotic guide, the Guía ABE, so you may not find it here. Spanish doctors usually prescribe one of these creams:
- Fusidic acid, sold as Fucidine. It is the UK's first-choice cream.
- Mupirocin, sold as Bactroban and generics.
- Ozenoxacin, sold as Ozanex, approved in Spain for non-bullous impetigo from six months of age.
All need a prescription in Spain. When tablets are needed, the choice depends on the case. Flucloxacillin is the UK first choice. The Spanish children's guide (Guía ABE) suggests cefadroxil first, with alternatives such as amoxicillin-clavulanic acid, and other options for penicillin allergy. Resistance to the creams is rising, so a doctor may take a swab if treatment fails.
See our guides to Fucidine (fusidic acid) and mupirocin.
Crusty sores on your child's face and not sure if it is impetigo?
You can book a video visit with a GP licensed in Spain, in English or Spanish. He looks at the sores on camera, checks for warning signs and explains the right treatment.
How do I stop impetigo spreading at home?
- Wash the sores gently with soap and water and pat dry.
- Keep nails short and try not to scratch.
- Wash hands often, especially after touching the sores or applying cream.
- Do not share towels, flannels or bedding. Wash them hot.
Is it impetigo or hand, foot and mouth disease?
Hand, foot and mouth disease is a virus. It causes fever, mouth ulcers and small spots or blisters on the hands, feet and bottom. It does not form honey crusts. Antibiotics do not help, and it clears on its own in 7 to 10 days. A child can go back to nursery once they feel well.
When should you see a doctor about impetigo?
Book a visit if:
- Your baby is under one year old.
- The sores spread or are not better after treatment.
- It keeps coming back.
- You are breastfeeding and the sores are on the breast.
- You have diabetes or a weak immune system.
See a doctor without waiting for sores near the eye, or if your child has a fever or seems unwell. Also seek care for redness, warmth or swelling spreading around the sores, which can mean cellulitis. A newborn with blisters needs to be seen urgently.
Call 112 or go to urgencias if a child is very drowsy, floppy or hard to wake. Also call for a fast-spreading rash with fever, or skin that peels in sheets.
Talking it through with a doctor by video
Dr. Yelamo is a GP licensed in Spain. He sees adults, children and pregnant patients by video, every day from 07:30 to 20:30 (Spain time). In the visit he will:
- Look at the sores on camera and ask how they started.
- Check for fever, spreading redness and other warning signs.
- Explain the treatment that fits and when your child can go back to school.
He does not promise any test or prescription before the visit. Where clinically appropriate, following a genuine evaluation. Treatment and prescriptions are issued solely at the doctor's discretion based on evidence-based clinical guidelines.
A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.
See how the Urgent Care video visit works. It lasts 15 minutes and costs €50.
This guide is general information. It does not replace a consultation with your doctor or paediatrician.
Frequently asked questions
What does impetigo look like?
Red sores or blisters that burst and form golden, honey-coloured crusts, usually around the nose and mouth or on the hands.
How long is impetigo contagious?
The NHS says until 48 hours after starting treatment. Without treatment it can stay contagious for 7 to 21 days, until the sores crust over.
When can my child go back to school?
Once they are no longer contagious. In the UK that is 48 hours after treatment starts. In Spain each school or nursery sets its own rule.
Can I buy impetigo cream without a prescription in Spain?
Fusidic acid, mupirocin and ozenoxacin creams all need a prescription in Spain. A pharmacist can sell antiseptics and advise you.
Is impetigo the same as hand, foot and mouth disease?
No. Impetigo is bacterial and forms honey crusts. Hand, foot and mouth disease is a virus that causes mouth ulcers and spots on the hands and feet. Antibiotics do not help it.
Sources
- NHS: Impetigo
- NICE NG153: Impetigo, antimicrobial prescribing
- CDC: About impetigo
- AEMPS CIMA: Ozanex (ozenoxacin) package leaflet
- NHS: Hand, foot and mouth disease
Related guides
Medical Citations & Sources
This content is written and reviewed by a licensed physician with reference to the following official health authorities.
