Impetigo is the most common skin infection in children. As a basis, two types of impetigo should be recognized and distinguished between them:

Impotigo is not bullous (not blistering ) – Caused mainly by a bacterium called Staphylococcus aureus (golden Staphylococcus aureus) but also by group streptococcus A. The same streptococcus that causes For sore throats in children , Although here it pollutes the skin.

Blistering impetigo (bullous) – always caused by special strains of Staphylococcus aureus that secrete toxins, with the help of which there is damage to the skin and a local blister is formed.

The difference is important for the purpose of understanding that while the first type almost always starts in an area of local trauma to the skin (stinging, rubbing, chickenpox, burns, etc.) then in the second type the child just gets up in the morning with a contaminated blister that the parents do not understand where it came from.

Where did the bacteria get to the children’s skin from?

From birth we all have many bacteria on the surface of the skin including the two aforementioned bacteria. In children these two bacteria is in greater quantity. Transmission of skin bacteria between children is common and then if one spring day your child rubs up in kindergarten with a child whose skin has a certain type of staphylococcus then the new bacterium on your child’s skin may lead to impetigo.

The area where the carrier is in the highest amount of staphylococcus is in the nostril area of the child. The child pokes its nose and transmits the bacterium to other places in the body. For streptococcus, the carrier is usually on the skin only, and the acquisition of the bacterium that settles on the child’s skin usually occurred about 10 days before the appearance of the lesions.

What do the lesions look like?

Impotigo is not bullous – usually on a wound that already exists, a yellowish area (honey color) is seen with local redness around it, a diameter of up to 2 cm. Sometimes itchy. See first picture.

Imptigo bullous – a blister with a clear contents whose roof cracks quickly and leaves a round area wet and inflamed, sometimes honey-colored. See both photos below.

So what are the main differences between the two types of impetigo?

Please table.

Not Bullous


Generating bacteria

Most often Staphylococcus

Always staphylococcus




The age of the children

little children

Babies and small children

Position in the body

Most often in the face and limbs

Face, torso and limbs

Is it happening on an area of local trauma?


Usually not


Most often local treatment with or without decolonization

Most often systemic treatment with or without decolonization

What are the complications of impetigo in children?

There are usually no systemic complications beyond the local infection which is unpleasant in itself. In uncommon cases there is exacerbation of local infection and sometimes local abscess formation.

It is common to see a recurrent infection in the same child or other children in the home.

What is the treatment of each type and from what principles is it derived?

The decision on who to treat and how depends on the nature of the lesions, their location and number.

In cases of Imptigo is not Bolusi In a confined space, a topical antibiotic ointment covering the aforementioned bacteria can usually be treated. See link .

In stubborn cases decolonization can also be added to the treatment, will be explained later.

In cases of significant local infection and spread of the infection, oral treatment with an appropriate antibiotic that is also directed against the two criminal bacteria that cause impetigo may be considered.

In Imptigo Bullous The approach is a little more aggressive because even if we treat it properly locally, the presence of this specific bacterium on the child’s skin will lead to the infection continuing and wounds will usually appear elsewhere as well.

Therefore in many cases seven days of antibiotic treatment with appropriate antibiotics will also be given at the same time. If you have started oral antibiotic treatment, there is usually no room for the addition of a local antibiotic ointment.

Here too in stubborn cases, either in recurrence of the infection or in the presence of the infection in a number of children at home, there is room to consider decolonization treatment.

In addition to all the above treatments, itching in the child should be prevented. The itching usually appears mainly at the stage when the lesions dry out (and actually heal), and the child worsens with the itching the wounds and infection. A wound that a child pokes at and opens several times is also a wound that may leave a scar. So cut the child’s nails and consult with the pediatrician about treatment to reduce the itching.

What is decolonization?

The presence of the bacterium on the skin is called colonization. The bacterium lives on us. Removal of the bacterium from the skin is called decolonization. By lowering the amount of the bacterium from the skin it can prevent the aggravation of the infection and its transmission to other family members.

How is it done?

A. An antibiotic ointment for the child’s nostril area. Twice a day for 5 days.

B. Bath with antiseptic soap every day for 5 days. Soap and wash (carrying is also on the scalp) with the antiseptic soap. After rinsing this soap, and since it dries the skin, moisture can be restored by using the usual soap and shampoo (in the same bath). This bath should be repeated for 5 consecutive days, and the mehadrin add a similar bath once a week for another 4 weeks.

from experience, Decolonization actually helps in overcoming recurrent impetigo events in the same child or between family members.

Is impetigo contagious?

Yes, impetigo is highly contagious in the same kindergarten or home, and those who are usually infected are children of the same age or younger. Most parents are less contagious. The infection is by touch but also by the use of bedding, towels and shared clothes.

When to return a child with impetigo to educational institutions?

As written in the section on the site that guides on Return of children to educational institutions , It is then possible to return to the educational institution about a day after starting appropriate antibiotic treatment and provided that all lesions that are open or secretive are covered.

So in conclusion, a very common disease in children. Sometimes the infection is stubborn so early and accurate management will greatly help get rid of these bacteria and reduce the morbidity in children.