Signs and Symptoms of Impetigo
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Medically reviewed by William Truswell, MD
Impetigo is a contagious skin infection, mostly caused by streptococcus (strep) or staphylococcus (staph) bacteria. This infection most commonly occurs in children and can spread through physical contact with a person or an object that is carrying the bacteria—especially in hot and humid conditions.
While the infection can develop on healthy skin, impetigo often forms on skin that has been broken by a cut, rash, bug bite, or other injury. Impetigo often begins with common infection symptoms like itchy, pus-filled blisters or sores. Within a week or so, the blisters may burst and leak, forming a gold-colored crust on the skin. However, there are three types of impetigo—and while the symptoms of each are similar, each infection is unique.
Common Symptoms
All types of impetigo cause pus-filled blisters or sores on the skin. These sores break open at some point, causing a crust to form on your skin. The lymph nodes near the site of your sores also may swell up as your body tries to fight off the infection.
Nonbullous Impetigo Symptoms
Nonbullous impetigo is the most common type of impetigo. With this type, itchy, pus-filled blisters form and then create a red rash once the sores pop. The rash then evolves into the characteristic appearance of a golden, or honey-colored, crust.
If you have nonbullous impetigo, your blisters will usually appear on the face, arms, or legs at first. But, this infection can spread to other parts of the body quickly. As such, it's important to seek treatment right away to prevent the infection from spreading. With treatment, symptoms clear up and usually do not leave scarring on the skin.
Bullous Impetigo Symptoms
Similar to nonbullous impetigo, bullous impetigo also causes pus-filled blisters. However, the key differences with bullous impetigo are as follows:
Fewer blisters
Blisters are larger, but not painful
There is no redness around the blisters
The color of the crust is more brown than golden in color
Symptoms show up more commonly on the abdomen, rather than on the face
Unfortunately, bullous impetigo is more likely to become a systemic infection than non-bullous impetigo. This means that the infection spreads throughout the body and can become dangerous, leading to serious complications like sepsis.
Symptoms of Sepsis
If impetigo spreads into your body and enters the bloodstream, you could develop sepsis, which is an extreme immune system response to an infection. With sepsis, you can experience:
Sepsis is a medical emergency that needs immediate treatment. Without treatment, you can develop septic shock, which is life-threatening.
Ecthyma Symptoms
Ecthyma is sometimes called deep impetigo because the infection affects deeper layers of your skin. This type of impetigo infection may develop from untreated cases of non-bullous or bullous impetigo.
Like the other two types of impetigo, ecthyma causes sores on the skin. But, these sores reach deeper into the skin and often develop on the legs.
Symptoms of ecthyma include:
Painful blisters that may have a “punched-out” or concave appearance
Sores that press deep into your skin once the blisters pop
Thick, yellow crust that is surrounded by red skin
Once the infection clears up with adequate treatment, ecthyma can sometimes leave scars on the skin.
Symptoms in Children
Up to 12% of children around the globe develop impetigo at some point in their childhood. Preschool-age children, between the ages of two and five, are the most common demographic to experience this infection. In fact, impetigo is 2.5 times more common in children than in adults. Bullous impetigo is especially common in children—and up to 90% of all bullous impetigo cases occur in children under the age of 2.
Children who are most vulnerable to impetigo tend to live in areas with:
Hot and humid (tropical) climate
Overcrowding
Lack of access to good sanitation and clean water
Symptoms of impetigo in children are very similar to those in adults. Itchy blisters full of fluid or pus appear, break open, and form a crusty scab. In infants, the skin may be more likely to become raw or red where the blisters have popped. Unlike adults, however, children are more vulnerable to experiencing impetigo symptoms even after their infection has healed.
When to Contact a Healthcare Provider
Seeking treatment for impetigo when you notice the first signs of infection is critical. Without treatment, the infection may spread to other parts of the body or to other people. Untreated impetigo may also spread deeper into the skin and become ecthyma, which is more likely to cause scarring.
You may also be at an increased risk of experiencing serious complications (like sepsis) if you do not receive treatment for your infection. In some cases, impetigo can also cause more rare complications like kidney disease or rheumatic fever. Additionally, newborn babies with impetigo can develop meningitis.
That said, don't wait too long before seeing a healthcare provider about your symptoms. Fortunately, impetigo is highly treatable with topical or oral antibiotics. But, treatment is more successful when the infection is caught early.
A Quick Review
Impetigo is a highly contagious skin condition that needs medical treatment to prevent the infection from worsening or spreading to others. Its symptoms usually begin as fluid-filled blisters or sores and then progress to a honey-colored crust as the blisters slowly pop. Anyone can contract an impetigo infection, but children who live in warm, crowded, or unsanitary conditions are most susceptible to the infection.
If you notice blistering or crusting on your or your child’s skin, call your healthcare provider as soon as you can. Without treatment, you can increase your risk of developing serious complications like sepsis or a more severe type of impetigo that can leave scarring on your skin.
Frequently Asked Questions
Where do symptoms of impetigo usually start?
Symptoms of impetigo usually develop on exposed skin, most commonly on the face, arms, and legs. Symptoms typically begin about 10 days after exposure to the bacteria that causes impetigo.
Can impetigo go away on its own?
About one in five cases of impetigo resolve on their own. However, it is best to seek treatment from a healthcare provider to reduce the risk of developing complications or spreading the infection to others.
How contagious are impetigo symptoms?
Impetigo symptoms are highly contagious. A person with impetigo can easily spread the infection to other people through skin-to-skin contact or by sharing items that carry the bacteria.
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