The problem: honey-coloured crusts on the face
A small red spot under the nose, two days later a blister that bursts, and then a yellowish crust that looks as if cornflakes were stuck to the skin. The patches can itch, sometimes they hurt, and they spread (NHS: Impetigo). The skin around the nose and mouth and the hands are often affected (NHS: Impetigo), but so are the arms and legs (DermNet: Impetigo).
Impetigo is the most common bacterial skin infection in children aged two to five (Hartman-Adams et al. 2014); adults can get it too (DermNet: Impetigo). It is caused by the bacteria Staphylococcus aureus and Streptococcus pyogenes, alone or together (DermNet: Impetigo). Specialists distinguish two forms: in the non-bullous form, about 70% of cases, the typical honey-coloured crusts develop; in the bullous form, about 30%, larger, flaccid blisters form, more often in skin folds (Hartman-Adams et al. 2014).
The table shows typical features described by specialist sources. It is a guide, not a diagnosis: only a medical examination gives certainty.
| What you see | What may be behind it |
|---|---|
| Red spots or blisters that burst quickly and leave honey-yellow to golden-brown crusts, often around the nose and mouth or on the hands | non-bullous impetigo (NHS: Impetigo), (DermNet: Impetigo) |
| Larger, thin-walled, flaccid blisters, more often in skin folds | bullous impetigo, caused only by staphylococci (Hartman-Adams et al. 2014) |
| Yellowish crusts on eczema, a scratched insect bite or a herpes sore | impetigo that has settled on already damaged skin (Hartman-Adams et al. 2014) |
| In a child with atopic eczema, sudden clusters of identical-looking, painful blisters, some with a dimple in the centre, later crusts; the child seems unwell and has a fever | eczema herpeticum, a herpes infection on eczema skin; it can resemble impetigo and is an emergency (DermNet: Eczema herpeticum) |
A cold sore is also one of the conditions a doctor rules out (DermNet: Impetigo); how to recognise it is explained in Cold sore, sunburn or chapped lips? How to tell the difference. A red, scaly ring around the mouth without crusts, on the other hand, is often lip-licking dermatitis; more in Lip-licking dermatitis in children: a red ring around the mouth in winter and what helps.
Why children – and why in autumn and winter too
Spread via the hands. Impetigo is usually passed on through direct contact. Scratching the crusts carries the bacteria to other areas of skin on the fingers; this creates new patches, including where two skin surfaces touch (DermNet: Impetigo). Towels and flannels can also pass the bacteria on (DermNet: Impetigo). Between infection and the first signs there are 2 to 10 days, not uncommonly longer (RKI: readmission). Untreated, children and adults can be contagious for up to three weeks, and longer if patches are still oozing pus (RKI: readmission). In nurseries and primary schools, where children play closely together, the infection therefore spreads easily.
Small skin damage as an entry point. Risk factors include skin conditions such as atopic eczema, contact eczema, scabies and chickenpox, as well as small injuries, grazes and insect bites (DermNet: Impetigo). Impetigo is more common in warm, humid months: in a study from Dutch general practices it occurred considerably more often in summer than in winter (Koning et al. 2006). In autumn and winter, however, there are other weak spots: a sore nose from constant blowing, cracked corners of the mouth, lip-licking dermatitis from licking and saliva in the cold, or a flare of atopic eczema. Exactly where the skin is already open or irritated, the bacteria can settle. How to care for a sore nose is explained in Sore nose from blowing: what the skin needs now.
When it keeps coming back. With recurrent impetigo, the doctor may take a swab from the nose, because staphylococci can live there (DermNet: Impetigo).
The solution step by step
| Step | What you do | Why |
|---|---|---|
| Straight away | Make an appointment with a paediatrician or GP; babies up to eleven months should see a doctor directly | Treatment is given by a doctor; babies may need tablets instead of a cream (NHS: Impetigo) |
| Until the appointment | Do not touch, scratch or pull off crusts and blisters; cut fingernails short | Scratching carries the bacteria to new areas (DermNet: Impetigo); not touching and short nails are recommended by specialist sources (NHS: Impetigo), (DermNet: Impetigo) |
| Treatment | Use the prescribed cream or tablets exactly as instructed and do not stop early, even if the skin looks better | With only a few patches, antibiotic creams are effective (Koning et al. 2012); with blisters or many patches, tablets are recommended (DermNet: Impetigo); do not stop early (NHS: Impetigo) |
| Every day at home | Wash hands often and thoroughly with soap, especially before and after applying cream to the patches; separate towels and flannels; wash towels, bedding and pillowcases at 60 °C or more | This is what the Robert Koch Institute recommends (RKI: readmission); do not share towels (DermNet: Impetigo) |
| Nursery, school, work | Inform the facility; the child stays at home until allowed back: 24 hours after starting effective antibiotic treatment, if patches are still oozing pus only once this has stopped, without antibiotics only after the skin has recovered | In Germany, impetigo is on the list in section 34 of the Infection Protection Act (IfSG § 34); the time frames come from the recommendations of the Robert Koch Institute (RKI: readmission) |
| Prevention afterwards | Have eczema, a sore nose or scratched bites looked after early; only care for the skin around the area once everything has recovered | Previously damaged skin is a common entry point (DermNet: Impetigo), (Hartman-Adams et al. 2014) |
The patches usually disappear within two to three weeks without scarring, and complications are rare (Hartman-Adams et al. 2014). With effective treatment, however, a child may return to nursery after just 24 hours, without treatment only once the skin has recovered (RKI: readmission).
What helps – and what tends not to
| Measure or home remedy | Assessment |
|---|---|
| Home remedies such as tea tree oil, honey, olive or coconut oil | not studied well enough to recommend them (Hartman-Adams et al. 2014); they do not replace medical treatment |
| Only disinfectant solutions instead of a prescribed treatment | better not: there is a lack of good evidence for disinfectants, and antibiotic creams performed better in studies (Koning et al. 2012) |
| Soaking off or scratching off crusts | no: this spreads the bacteria; whether and how crusts are loosened before applying cream is something the doctor will tell you |
| Rich cream, zinc ointment or oil on the crusts | no: skin care does not belong on infected skin; only after it has recovered |
| Stopping the antibiotic cream as soon as it looks better | no: use it until the end of the prescribed course (NHS: Impetigo) |
| Separate towels, hand washing, hot laundry | yes: these are the hygiene measures named by the Robert Koch Institute (RKI: readmission) |
Common mistakes
Mistaking the crusts for lip-licking dermatitis or a sore nose and applying rich cream to them for a week. Taking the child back to nursery the next morning because they feel fine; what matters is not how they feel but whether they are still contagious. Applying the cream with a finger and not washing your hands afterwards. One towel for the whole family. Stopping treatment as soon as the crusts fall off. And: overlooking that a child with atopic eczema suddenly has painful blisters that are not impetigo.
When should you seek medical advice?
Whenever you suspect impetigo, because it is treated by a doctor, and for nursery and school in Germany the doctor's assessment is what counts (IfSG § 34). You should also see a doctor soon if
- a baby up to eleven months is affected (NHS: Impetigo),
- you are pregnant or breastfeeding, especially if patches appear on the breast (NHS: Impetigo); the doctor will then choose a suitable treatment,
- the immune system is weakened, for example by chemotherapy (NHS: Impetigo),
- the patches change or get worse despite treatment, or impetigo comes back within a year (NHS: Impetigo),
- your child feels ill in the weeks afterwards; a streptococcal infection can rarely be followed by kidney inflammation (DermNet: Impetigo).
On the same day, see your doctor or, outside opening hours, the German out-of-hours medical service on 116 117 if fever develops or redness spreads quickly into the surrounding skin; the infection can go deeper into the skin (DermNet: Impetigo). The same applies if a child with atopic eczema suddenly develops many painful blisters and seems unwell: eczema herpeticum is one of the few emergencies in dermatology (DermNet: Eczema herpeticum).
Frequently asked questions
How long is impetigo contagious?
Untreated, up to three weeks, and longer if patches are oozing pus. With effective antibiotic treatment, a child may go back to nursery after 24 hours if no patches are oozing pus any more.
When can my child go back to nursery or school?
24 hours after starting effective antibiotic treatment, if no patches are oozing pus any more. Without antibiotics, only once the skin has recovered. You must inform the facility about the illness.
What does impetigo look like?
Typical are red spots or blisters that burst and form honey-yellow to golden-brown crusts, often around the nose and mouth or on the hands. In the less common bullous form, larger, flaccid blisters develop.
What causes impetigo?
Bacteria, staphylococci or streptococci, that are passed on via hands, skin contact or towels. They like to settle on skin that is already damaged, for example by eczema, an insect bite or a sore nose.
Can adults get impetigo too?
Yes, even though it is most common in small children. For adults working in a nursery or school in Germany, section 34 of the Infection Protection Act also applies: they may not look after children there while they are contagious.
What applies during pregnancy?
See a doctor soon. They will choose a treatment that is suitable during pregnancy; do not use remedies from your medicine cabinet on your own.
Do home remedies help against impetigo?
Tea tree oil, honey or oils have not been studied well enough to recommend them. They do not replace medical treatment, and fat does not belong on infected crusts.
Impetigo or herpes?
Herpes forms clusters of identical-looking blisters, often on the lip. Impetigo shows honey-coloured crusts and spreads. Both can also occur together; a doctor can tell them apart reliably.
At forpeople
We have no product for impetigo, and our skin care products do not belong on crusts, blisters or open skin. Any soap will do for washing hands; more important than the product is that everyone in the household uses their own towel.
Once the skin has recovered, prevention is what matters: caring early for a sore nose and lip-licking dermatitis during the cold season takes away the bacteria's entry point. For children, an unperfumed product without essential oils is what is needed; discuss which one suits with your paediatrician.
More on this: Cracked corners of the mouth: causes, care and when to see a doctor · Scabies or eczema? How to recognise scabies and what to do now · Recognising a fungal skin infection: round, scaly patches on the body – fungus or eczema? · Dry skin or atopic eczema? How to tell the difference
Sources
- Robert Koch Institute (RKI): Empfehlungen für die Wiederzulassung zu Gemeinschaftseinrichtungen gemäß § 34 Infektionsschutzgesetz [Recommendations for readmission to community facilities under section 34 of the Infection Protection Act]. Status 23 October 2026 (impetigo contagiosa section: 9 March 2023), accessed 30 October 2026. https://www.rki.de/DE/Aktuelles/Publikationen/RKI-Ratgeber/Wiederzulassung/Mbl_Wiederzulassung_schule.html
- Infektionsschutzgesetz (IfSG) [German Infection Protection Act], § 34. Accessed 30 October 2026. https://www.gesetze-im-internet.de/ifsg/__34.html
- DermNet: Impetigo. Quirke K (March 2022), accessed 30 October 2026. https://dermnetnz.org/topics/impetigo
- NHS: Impetigo. Last reviewed 6 June 2024, accessed 30 October 2026. https://www.nhs.uk/conditions/impetigo/
- Hartman-Adams H, Banvard C, Juckett G (2014): Impetigo: diagnosis and treatment. American Family Physician 90(4): 229–235. PubMed: https://pubmed.ncbi.nlm.nih.gov/25250996/
- Koning S, van der Sande R, Verhagen AP, van Suijlekom-Smit LW, Morris AD, Butler CC, Berger M, van der Wouden JC (2012): Interventions for impetigo. Cochrane Database of Systematic Reviews 2012(1): CD003261. https://doi.org/10.1002/14651858.CD003261.pub3
- Koning S, Mohammedamin RS, van der Wouden JC, van Suijlekom-Smit LW, Schellevis FG, Thomas S (2006): Impetigo: incidence and treatment in Dutch general practice in 1987 and 2001 – results from two national surveys. British Journal of Dermatology 154(2): 239–243. https://doi.org/10.1111/j.1365-2133.2005.06766.x
- DermNet: Eczema herpeticum. Lin CY (2010), updated May 2023, accessed 30 October 2026. https://dermnetnz.org/topics/eczema-herpeticum
