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Impetigo in Children: Causes, Symptoms, Treatment, and Prevention

Etiology

Non-bullous (70%): S. aureus (often MRSA), S. pyogenes.
Bullous: S. aureus exfoliative toxins A/B.

Clinical Presentation

Honey-colored crusted erosions (non-bullous).
Fragile flaccid bullae → erosions with collarette scale (bullous).
Common sites: face (perinasal), extremities.
Contagious—spreads by autoinoculation & contact.

Treatment

Adjunctive Care

Gentle cleansing with soap/water 2×/day; remove crusts.
Cover lesions to prevent spread.
Trim nails; separate towels/linens.
Return to school 24 h after antibiotic initiation if afebrile.

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Severity	Regimen
Localized (≤5 lesions)	Topical mupirocin 2% or retapamulin 1% BID × 5–7 d
Extensive / bullous / systemic signs	Oral cephalexin 25–50 mg/kg/d ÷ q6h × 7 d (adjust for MRSA)