When can someone with bullous impetigo return to school and sports?

Return to School and Sports After Bullous Impetigo

Individuals with bullous impetigo should not return to school or sports until they have completed at least 24 hours of appropriate antibiotic therapy AND have no moist, weeping, or draining lesions. 1

Treatment Requirements Before Return

• Completion of at least 72 hours of appropriate antibiotic therapy with visible signs of lesion resolution 1
• No new skin lesions for at least 48 hours before returning to school or competitive activities 1
• All lesions must be dry with well-adhering scabs; no moist, exudative, or draining lesions should be present at the time of return 1

Specific Guidelines for Bullous Impetigo

Initial Treatment

• Topical mupirocin may be used for localized and non-bullous impetigo 1
• For bullous impetigo, which is invariably caused by Staphylococcus aureus, systemic antibiotics are typically required 2
• First-line systemic therapy is typically oral flucloxacillin or another appropriate anti-staphylococcal antibiotic 2
• For methicillin-resistant S. aureus (MRSA), alternatives include trimethoprim-sulfamethoxazole, doxycycline, or clindamycin for susceptible isolates 1

Monitoring for Resolution

• Bullous impetigo typically resolves within 2-3 weeks without scarring when properly treated 3
• Monitor for complete drying of all lesions and formation of firm, adherent crusts 1
• Ensure no new lesions have developed for at least 48 hours before returning to school 1

Special Considerations for Athletes

• Athletes with skin infections should not return to competitive sports for at least 24 hours after beginning appropriate oral antimicrobial therapy 1
• For organized sports, particularly contact sports like wrestling, guidelines may be more stringent 1
• National Collegiate Athletic Association (NCAA) and National Federation of State High School Associations (NFHS) guidelines specify:
  • Completion of 72 hours of antibiotic therapy with lesions resolving 1
  • No moist or draining lesions; all lesions should have well-adhering scabs 1
  • Scabbed and/or dry lesions only can be covered with bio-occlusive dressing 1

Prevention of Spread

• Active purulent lesions cannot be covered to allow participation; the athlete must be excluded until properly treated 1
• Good hygiene practices are essential to prevent spread, including:
  • Not sharing equipment or water bottles 1
  • Limiting exposure to infected people and contaminated surfaces 1
  • Prompt identification and proper treatment of infected individuals 1

Important Caveats

• Bullous impetigo is highly contagious and can spread rapidly in school and athletic settings 3
• The lesions may take 2-3 weeks to fully resolve, but return to school/sports is possible earlier with appropriate treatment 3
• For extensive cases or those with systemic symptoms, longer treatment and exclusion periods may be necessary 2
• Local health department regulations may have additional requirements for return to school or sports 1

Remember that bullous impetigo is at the mild end of a spectrum of blistering skin diseases caused by staphylococcal exfoliative toxins, and proper treatment is essential to prevent more serious complications 2.