School sores

Also known as impetigo

School sores is the common name for impetigo. It is a highly contagious skin disease common in children.

Key points

  1. Impetigo is a very contagious skin infection. This means it easily spreads from one person to another.
  2. Impetigo is found generally on the hands and face, especially around the nose and mouth. It can also affect other areas.
  3. Children should see a doctor for assessment and treatment. Careful cleaning of the sores and the use of antiseptic or antibiotic cream may be advised. Sometimes oral antibiotics are prescribed.
  4. Children should be kept away from school or day care until the sores are healed, or as advised by your doctor.

Causes

undefinedImpetigo is a common skin infection caused by two types of bacteria: Streptococcus progenies (strep) or Staphylococcus aureus (staph). Some people carry the bacteria in their nostrils. This can be transferred to the hands and then onto other parts of the skin. 

Most of the time, the skin is an effective barrier that keeps bacteria out. When there is a break in the skin, bacteria can enter the body. There it can grow, causing inflammation and infection. Breaks in the skin may occur with any bites (insect, animal or human) or injury to the skin. Impetigo may also occur on skin where there is no visible break.

Who gets impetigo?

Impetigo can be spread to other people by contact with the sores. The sores are most infectious when there is weeping or crusting.

Impetigo is most common in children, particularly those in poor or crowded houses. In adults, it may follow other skin disorders. It is also more common in people with lower immune function.

Symptoms

Impetigo usually starts as little blisters. These then break and start to weep, usually pus, and sometimes clearer liquid. The weeping patches tend to grow larger. Yellow or brownish scabs then form which can burn or itch.

Impetigo can also starts as any lesion (bite, damaged skin) that doesn't heal and develops a crusty scab. Sometimes it looks like a rash– which may begin as a single spot, but if a person scratches, it may spread to other areas. You may develop swollen lymph nodes similar to the infection (lymphadenopathy).

Diagnosis

  • Impetigo can usually be diagnosed based on the how it looks and a description of how it came about. For images of impetigo from DermNet
  • Sometimes a skin swab is needed if it keeps coming back or doesn't get better with treatment.
  • A swab is also taken if there is concern that an antibiotic resistant strain of bacteria such as MRSA is the cause.

Treatment

As soon as you think your child might have impetigo, take them to the doctor. Treatment will depend on the how severe the infection is. The doctor may prescribe a course of antibiotic tablets. These are usually taken over seven days. Antibiotic creams and ointment are sometimes used. However, these aren't used as much now because overuse can allow the bacteria to gain resistance to the antibiotic. Antiseptic ointments may also be recommended.

Carefully follow the treatment from your doctor. If prescribed oral antibiotics, continue taking the medicine for the full course, even if the sores look to have healed. Oral antibiotics can sometimes have side effects. Report any diarrhoea, stomach upsets or skin rashes to your doctor or practice nurse.

In some cases the doctor may also prescribe an ointment to rub on the inside of the nostrils for the child and other family members – the bacteria can hide out there and reinfect others.

How to apply topical medications

  • If an antiseptic (such as povidone iodine, hydrogen peroxide cream or chlorhexidine) or antibiotic ointment (such as fusidic acid, or mupirocin) is prescribed, apply it two or three times a day to the affected areas and surrounding skin.
  • Remove crusted area by washing with saline or antibacterial soap (1 to 3 times each day).
  • You can also soak lesions with a mixture of half a cup of white vinegar in a litre of warm water. Apply a cloth soaked in this mix to moist areas for about ten minutes three times a day. Gently wipe off the crusts.
  • Apply the cream or ointment.
  • Look carefully for new lesions to treat. Continue for several days after healing.
  • Keep affected areas covered with plaster or dressing and stay away from school or childcare until at least 24 hours after treatment started.
  • Wash (do not scrub) the skin several times a day, preferably with an antibacterial soap, to remove crusts and drainage.

Moderate infection or not responding

If the child does not get better with treatment or if the sores return, contact your doctor, as you may need a different treatment or further investigation into the cause. More severe cases may require antibiotics, taken by mouth such as flucloxacillin.

Self care

Impetigo sores can look alarming and may be difficult to manage, especially if they are on the face.  Dry sores do not need to be enclosed but weeping sores should be washed and kept covered (dressed).

Follow the recommendations of your doctor about caring for the sores.

General cleaning regimen

  • Wash your own hands with warm water and soap. Dry your hands thoroughly with a clean towel or a disposable kitchen wipe. Check that your hands are free from cuts or scratches so you do not become infected.
  • Wash the sores with warm water and soap (or the lotion your doctor recommends) and try to gently bathe the crusts away.
  • Wash your hands again using the method described above.
  • Apply the antiseptic or antibiotic cream (as advised by your doctor).
  • Cover the weeping sore with a dry dressing. Dressings and the correct tapes to hold the dressing in place can be purchased from pharmacies.
  • Throw old dressings into a plastic bag and seal it before discarding.
  • Wash your hands again.

Prevention

Impetigo is very contagious. Follow your doctor’s advice about when the child can return to school or preschool.

  • Make sure you have your own towel, soap and face towels, and never share them (disposable paper towels are useful).
  • Keep bed linen, clothes and towels separate.
  • All family members should use an antibacterial soap – flowing soap pump packs are ideal.
  • Keep fingernails cut short. Avoid scratching or picking at sores.
  • Keep sores covered with a dressing, such as gauze and tape.
  • Wash your hands thoroughly before preparing food.

For more information and support talk to your doctor or practice nurse, your local pharmacist, or ask to speak to the public health nurse attached to the school. You can also phone Healthline free (within New Zealand) on 0800 611 116 for health advice.

Learn more

Images of Impetigo DermNet NZ
Impetigo - School Sores Kidshealth NZ 

Credits: Written by Health Navigator.