Differential diagnosis for impetigo

Impetigo often begins as small red spots, blisters or sores that break and leave a yellow-brown crust. It commonly affects exposed skin and can spread through scratching or close contact. Clinicians consider the speed of change, the pattern of lesions, pain or itch, fever, recent skin injury and whether others nearby have similar sores.

Atopic dermatitis can become infected and may produce oozing and crusting, while an eczema flare without infection tends to follow a recurring itchy pattern. Contact dermatitis, cold sores, fungal infection and insect bites can also resemble impetigo. A crust alone does not establish the diagnosis; examination is usually central.

Keep sores clean and gently covered, wash hands frequently, avoid scratching and do not share towels, clothing or cosmetics. A clinician may recommend topical antibiotic therapy for a limited area or oral antibiotics when lesions are more extensive or deeper. Use prescribed treatment for the full advised course and keep children away from close-contact activities until a clinician says return is appropriate.

Do not use leftover antibiotics or steroid creams on a suspected infection without advice. Tell the clinician about eczema, allergies, recent medicines and whether the rash is spreading despite care.

Arrange prompt assessment when sores spread quickly, involve the eyes or mouth, recur, or fail to improve with directed care. Seek urgent help for fever, marked swelling, increasing warmth, severe pain, unusual sleepiness or a child who appears unwell. Widespread crusting or signs of dehydration also need timely review.

Ask whether the appearance fits impetigo or infected eczema, whether a swab is useful, which treatment is appropriate for the affected area, and how long to avoid close contact. Ask how to reduce spread at home and what change should trigger a follow-up visit.