GPAtlas🔍 When to Suspect
A child presenting with discrete vesicles or pustules that rupture to form characteristic golden or honey-coloured crusts, usually around the nose and mouth
From the full topic in The Ocean Library: Impetigo
🧭 When to suspect
Impetigo is a highly contagious superficial bacterial skin infection, most common in children aged 2 to 5 years but seen at any age. It is caused by Staphylococcus aureus, Streptococcus pyogenes, or both, and typically follows a breach in the skin barrier – a graze, insect bite, cold sore, or underlying eczema.
Suspect it in a patient with discrete lesions around the nose and mouth that begin as thin-walled vesicles or pustules and rupture to leave the characteristic golden, honey-coloured crusts. The less common bullous form presents with flaccid, fluid-filled blisters and is more often seen in neonates and infants.
The two clinical priorities in primary care are to match treatment to the extent and type of disease – supporting antibiotic stewardship – and to recognise the minority who are systemically unwell or developing complications.
| Feature | Non-bullous impetigo (~70%) | Bullous impetigo (~30%) |
|---|---|---|
| Organism | S. aureus and/or S. pyogenes | S. aureus (exfoliative toxin-mediated) |
| Lesion | Vesicles/pustules rupturing to golden, honey-coloured crusts ("stuck-on cornflakes") | Flaccid bullae over 1 cm that rupture, leaving a thin brown crust with a peripheral collarette of scale |
| Typical site | Face – around the nose and mouth; also limbs | Trunk, flexures and nappy area; can be more widespread |
| Who | Any age; most common in young children | More common in neonates and infants |
|
🧠 Clinical pearl Bullous impetigo is driven by staphylococcal exfoliative toxins acting locally. In a neonate or infant, when those toxins spread systemically the picture shifts to staphylococcal scalded skin syndrome (SSSS) – widespread tender erythema with superficial peeling and a positive Nikolsky sign. This is a different, more serious entity needing urgent admission, not a topical cream. |
Source: NICE NG153
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