What is the typical healing time for impetigo?

Impetigo Healing Timeline

Impetigo typically resolves within 2-3 weeks without treatment, but with appropriate antimicrobial therapy, most cases heal within 7-10 days. 1, 2

Types of Impetigo and Healing Expectations

• Nonbullous impetigo (70% of cases)

  • Characterized by honey-colored crusts on face and extremities
  • Caused by Staphylococcus aureus or Streptococcus pyogenes
  • Begins as erythematous papules that evolve into vesicles and pustules

• Bullous impetigo (30% of cases)

  • Characterized by large, flaccid bullae that may rupture
  • Caused exclusively by toxin-producing strains of S. aureus
  • More likely to affect intertriginous areas

Healing Timeline Based on Treatment Approach

With Appropriate Treatment:

• Topical antibiotic therapy (mupirocin or retapamulin):

  • Noticeable improvement within 24-48 hours
  • Complete resolution typically within 5-7 days 1

• Oral antibiotic therapy (for extensive disease):

  • Improvement within 24-72 hours
  • Complete resolution typically within 7-10 days 1
  • Standard treatment duration is 7 days 3

Without Treatment:

• Natural resolution typically occurs within 2-3 weeks 2
• May leave temporary depigmented areas but usually heals without scarring 1

Factors Affecting Healing Time

1. Extent of infection:

   • Limited lesions heal faster than widespread infection
   • Bullous impetigo may take slightly longer to resolve completely

2. Treatment compliance:

   • Consistent application of topical antibiotics or adherence to oral regimen accelerates healing

3. Bacterial resistance:

   • MRSA infections may respond more slowly to standard treatments

4. Host factors:

   • Advanced age, malnutrition, diabetes, immunocompromised status may prolong healing 1

Contagiousness Timeline

• Impetigo remains contagious until:
  • 24 hours after starting appropriate antimicrobial therapy, OR
  • Until lesions are no longer present if left untreated 1

Important Clinical Considerations

• Children can typically return to school or daycare 24 hours after beginning appropriate antimicrobial therapy 1
• Athletes with impetigo should not return to competitive sports for at least 24 hours after beginning appropriate oral antimicrobial therapy 1
• Monitor for rare complications such as poststreptococcal glomerulonephritis, especially with group A streptococcal impetigo 2

Common Pitfalls to Avoid

• Inadequate treatment duration: Stopping treatment prematurely when lesions appear improved but before complete resolution
• Inappropriate antibiotic selection: Penicillin alone is not effective for impetigo treatment 1
• Delayed treatment: Postponing treatment can lead to longer healing time and increased risk of spread
• Using topical disinfectants: These are inferior to antibiotics and should not be used 2

By following appropriate treatment guidelines, most cases of impetigo will show significant improvement within a few days and complete resolution within 7-10 days.