What are The Possible Complications of Impetigo and How Can You Help Prevent Them?

“It can be an insect bite, then a secondary bacterial invasion — impetigo — and hopefully nothing further because we will not let it go any deeper,” says Charles Shubin, MD, a pediatrician with Mercy Family Care Physicians in Baltimore.

Treatment of impetigo is swift if a parent notices signs of the infection — such as red sores on the child’s nose, mouth, hands, or feet — and seeks help from a healthcare provider. “Usually impetigo will appear with honey-colored substances on the skin,” says Vikash S. Oza, MD, a pediatric dermatologist at NYU Langone Health in New York City. “They’ll start as very tiny superficial sores or tiny bumps that form a particular crust right on top of it.” The honey-colored crusts take the place of the sores once they burst. (1)

Dr. Shubin says impetigo is extremely common among children, especially in warmer months. “They’re outside, they’re getting dirtier, they’re doing things they wouldn’t do inside,” he says. They also may be getting more bug bites or scrapes in the summer, which can increase the risk of developing impetigo.

Diagnosing Impetigo: What to Expect if You See Your Primary Care Doctor or Dermatologist

Healthcare providers normally can identify impetigo simply by looking at the infection because it has such distinctive characteristics. But because doctors normally diagnose simply based on appearance, misdiagnoses can occur, too.

Shubin admits impetigo is a bit misunderstood. “Impetigo is a bacterial infection of the skin,” he says. “That sounds pretty straightforward, but there are things that look like impetigo that aren’t.” A doctor may also diagnose something as impetigo when really it’s something else. “There are things that mimic it, and that’s why you may want to see a provider for a diagnosis,” Dr. Oza says.

Impetigo is sometimes mistaken for:

Herpes “Fever blisters look like they could be impetigo in many cases, and when they burst, they crust, and crusting is a very common presentation of impetigo,” Shubin says.

Shingles Shingles occurs more often in adults than children, and it’s accompanied by something impetigo normally is not: pain. “Shingles really hurts because it’s in the nerve,” Shubin says. “Impetigo, on the other hand, is quite superficial, and if it gets deep one could argue it shouldn’t be called impetigo.” Impetigo can sometimes be itchy, but it’s not usually painful. (2)

Hand-Foot-and-Mouth Disease Normally, the dead giveaway that it’s hand-foot- and-mouth disease and not impetigo is the appearance of sores inside the mouth. “Impetigo by definition is a skin infection,” Shubin says. “There is no skin in the mouth, so if it’s in the mouth, it’s not impetigo.”

That sounds simple enough, but it’s complicated by the fact that the current strain of hand-foot-and-mouth disease in the United States results in lesions forming around the mouth and not just inside the mouth, Oza says.

So how can you tell them apart? With hand-foot-and-mouth disease, “you should get a widespread rash where you have red spots on the palms and soles and occasionally elsewhere on the arms and legs,” Oza says. It’s also usually accompanied by other symptoms, including fever, sore throat, and loss of appetite. (3)

Is It Shingles or Something Else?

Shingles and impetigo share similar characteristics, and the same goes for shingles and a number of other skin conditions. Find out exactly what shingles looks like here.

Treating Impetigo: What Your Healthcare Provider May Recommend

“There are two bacteria that cause impetigo: staph and strep,” Shubin says. Streptococcus (which causes strep throat) thankfully responds to antibiotics, but staphylococcus (which causes staph infection) has “become increasingly resistant to anything we have,” he says.

Shubin says he normally will prescribe Keflex (cephalexin) for impetigo to treat both strains of bacteria simultaneously. Another reason he frequently prescribes it: “It's delicious,” he says. “That really matters. You want a kid to take medicine for 10 days, it better be quite acceptable.”

Once treatment begins, the infection will likely go away within a few days, though it’s important to completely finish the antibiotics prescribed by the doctor to keep the infection from appearing again.

What Complications Can Arise if Impetigo Is Left Untreated?

Impetigo isn’t usually anything to worry about when you treat it. Even scarring isn’t much of a concern, unless the child scratches a lot, says Suzanne Friedler, MD, a board-certified fellow of the American Academy of Dermatology and a clinical instructor at Mount Sinai Medical Center in New York City.

Spreading the Infection to Others

This is the biggest thing to worry about when it comes to impetigo. “The most obvious complication is it will continue to spread to other areas, and you’ll see crusting and sores on the skin,” Oza says.

To minimize the chances of spreading to other parts of the body, Shubin suggests parents take measures to keep kids from harboring bacteria under their fingernails. Impetigo doesn’t usually itch too much, but it can be uncomfortable and kids may pick at the infected sores. (1) “As we used to do with chicken pox, we’d tell people to trim their child’s nails,” he says. “If they’re still scratching, put socks on the hands so they’re not going to dig the skin up.” Dr. Friedler says impetigo could end up affecting the face and the eyes, where it can cause swelling. Or it could spread from the outermost layers of the skin to deeper layers. (4)

Bacterial Infections

If impetigo continues to spread and worsen, other bacterial infections can result. Impetigo that progresses without being treated can turn into abscesses (or boils) on the skin, Shubin says. “Then it’s no longer impetigo,” he says. The recommended treatment changes radically with the development of abscesses. “Abscesses don’t really respond to antibiotics; they respond to drainage,” Shubin says.


Impetigo can also lead to cellulitis, which is an infection that affects the tissue beneath the skin. (1) Cellulitis usually appears as red, swollen skin that feels warm to the touch. (5) In children, it most likely will show up on the face or neck, while adults tend to see it on their lower legs. Cellulitis is pretty common, but it can become serious if it goes untreated and spreads to the lymph nodes and bloodstream. (1) It could be life-threatening if it causes permanent damage to the lymph vessels, which play a role in the way the immune system functions. (5)

Rarely, Rheumatic Fever

Though it’s not common, it’s possible for impetigo to lead to rheumatic fever. (6) This anti-inflammatory disease is caused by Group A streptococcus infections, and, like impetigo, it affects children (though usually a bit older — those ages 5 to 15). In most cases, rheumatic fever starts as strep throat rather than a skin infection like impetigo. It’s very rare in the United States, but something to be aware of because it can cause serious damage to the heart. Be on the lookout for signs of rheumatic fever, which include fever, joint pain, fatigue, and chest pain. (7)

Also Rarely, Poststreptococcal Glomerulonephritis

Leaving impetigo untreated means the bacteria could eventually hit the bloodstream. Once that happens, the potential complications become quite serious. The most serious potential complication is poststreptococcal glomerulonephritis. (996' target='_blank' rel='noopener noreferrer' >8) This is a kidney disorder that starts somewhere else on the body, such as on the skin, and eventually moves into the kidneys. (9)

Streptococcus bacteria causes inflammation within the blood vessels of the kidneys, which can keep the kidneys from being able to filter urine and could lead to kidney failure. It normally occurs after having a skin infection like impetigo for three or four weeks and leaving it untreated. (9)

How to Spot Signs of an Impetigo Complication

“These [complications] are very rare, but it’s the reason we emphasize why if you’re accurately diagnosed with impetigo you should have treatment,” Oza says. In general, impetigo shouldn’t be accompanied by other symptoms, like fever, loss of appetite, vomiting, or unusual drowsiness. If any of those side effects do occur, be sure to visit a health care provider. (10)

How to Help Prevent Impetigo From Recurring

Having impetigo once doesn’t make you immune to the bacteria, so there’s a chance you or your child will contract it again. (4) The best way to reduce the risk is to maintain healthy skin. For instance, if you or your child has dry, cracked skin, using moisturizer regularly can make a world of difference. “Skin is an excellent barrier,” Shubin says. “Our skin does a wonderful job of protecting us.”

6 Ways to Spring-Clean Your Skincare Routine

Cuts and bug bites are inevitable, though. Once you see something, cover up the area where the skin has been compromised with Bactroban (mupirocin) and a bandage, Friedler suggests. “If someone has healthy skin, they’re much less likely to get [impetigo],” she says.

And if someone else in your household or your child’s class or day care has impetigo, be diligent about practicing good hygiene. Wash your hands often, avoid sharing towels with anyone who’s infected, and set the laundry cycle to hot (ideally with a water temperature of at least 140 degrees F) to kill bacteria. (4)

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