What should you know about bullous and nonbullous impetigo?

Nonbullous impetigo commonly begins as small spots or blisters that break and leave a characteristic yellow-brown crust. Bullous impetigo produces larger, fragile fluid-filled blisters that may leave a moist red surface when they open. Both forms can spread by direct contact or through shared towels and other personal items.

Impetigo may enter through irritated, scratched, or broken skin. It can also affect skin already inflamed by another condition such as atopic dermatitis. Crusting skin is a useful clue, but a clinician may need to examine the area to distinguish impetigo from eczema, insect bites, or other rashes.

Arrange a clinical assessment, especially when blisters are spreading, several areas are involved, or a child is affected. Treatment may involve prescribed topical antibiotic therapy for a limited area or an oral antibiotic for more extensive infection; the choice depends on the examination.

Gently clean the area, avoid picking the crusts, cover lesions when practical, and wash hands after touching the skin. Do not share towels, clothing, bedding, cosmetics, or razors. Launder items that contact the lesions and follow the prescribed course exactly.

Seek prompt care if infection is rapidly spreading, very painful, associated with fever, near the eyes, or accompanied by marked swelling. Urgent assessment is also appropriate if the person seems unusually drowsy, weak, or unwell, or if treatment is not helping.

Does this look like bullous or nonbullous impetigo? Is topical treatment enough for the area involved? How should dressings and household laundry be handled? When can the person return to close-contact activities?