Synopsis
Distinguish superficial impetigo and folliculitis from a drainable abscess, use proportionate topical or oral therapy and manage recurrence, transmission and invasive complications.
- Non-bullous impetigo causes thin-walled vesicles or pustules that rupture into characteristic golden or honey-coloured crusts.
- Bullous impetigo produces flaccid fluid-filled blisters from toxin-producing Staphylococcus aureus and usually needs oral treatment.
- Folliculitis is a superficial pustule centred on a hair follicle; many limited cases improve with hygiene and removal of friction or occlusion.
Key red flags
Pain out of proportion, bullae, anaesthesia, necrosis or crepitus suggests necrotising infection.
A tender fluctuant nodule with pointing, pus or an ultrasound-defined cavity indicates a collection needing incision and drainage.
Investigation priorities
Define superficial versus deep disease, extent, drainable pus, lymphangitis and critical-site involvement.
Management branches
Non-bullous impetigo is localised and the patient is systemically well.
- Confirm the crusted superficial pattern and exclude herpes, eczema flare, ecthyma, cellulitis and bullous or widespread disease.
- Offer hydrogen peroxide 1% cream two or three times daily for five days when suitable and explain gentle crust cleansing and hand hygiene.
Key medicines
Hydrogen peroxide 1% creamApply a thin layer two or three times daily for five days to localised non-bullous impetigo when the preparation is suitable.
Fusidic acid 2% creamApply a thin layer three times daily for five days when localised non-bullous impetigo requires a topical antibiotic and antiseptic is unsuitable.