Impetigo is one of the most common bacterial skin infections in England, particularly among children under five. Red sores that burst and leave golden-brown crusts are the hallmark — and until recently, getting treatment meant booking a GP appointment and waiting days for antibiotics.

Since the NHS Pharmacy First service launched in January 2024, community pharmacists across England have been authorised to assess and treat impetigo directly, without the need for a GP referral. For parents dealing with a child's skin infection, or adults with a spreading rash, this means same-day treatment is now available at your local pharmacy.

What Is Impetigo?

Impetigo is a highly contagious bacterial skin infection caused by Staphylococcus aureus or Streptococcus pyogenes. It typically presents as:

• Non-bullous impetigo (most common): red sores, usually around the nose and mouth, that burst and leave honey-coloured crusts
• Bullous impetigo: larger, fluid-filled blisters on the trunk, arms, or legs — more common in children under two

The infection spreads through direct contact or sharing towels, and children are often excluded from nursery or school until treatment has been started and sores are crusted over.

How Pharmacy First Works for Impetigo

Under the Pharmacy First programme, your pharmacist can:

1. Assess the infection — examining the affected skin, asking about symptoms and duration, and checking for signs of more serious infection
2. Prescribe antibiotics — either a topical antibiotic cream (such as fusidic acid) for localised impetigo or oral antibiotics (such as flucloxacillin) for more widespread cases
3. Provide hygiene advice — how to prevent spreading the infection to other family members

The consultation is free on the NHS. No appointment is needed — simply walk into a participating pharmacy and ask for help.

When to Go to the Pharmacy vs the GP

Go to the pharmacy if:

• You or your child has a small number of sores (localised impetigo)
• The infection has appeared recently (within the last few days)
• The person is otherwise well with no fever

See a GP or call 111 if:

• The infection is widespread or rapidly spreading
• There are signs of deeper infection (increasing pain, swelling, fever)
• The person has a weakened immune system
• The infection does not respond to the initial course of treatment

What to Expect During the Consultation

A Pharmacy First consultation for impetigo typically takes 10–15 minutes. The pharmacist will:

• Ask when the sores first appeared and how they have changed
• Examine the affected area
• Check whether any household members are also affected
• Decide on the most appropriate treatment
• Explain how to apply the cream or take the tablets
• Advise on hygiene measures to prevent spread

If the pharmacist considers the case too complex — for instance, if they suspect the infection is caused by MRSA or if the patient has significant comorbidities — they will refer you to a GP.

Treatment Options

According to NICE clinical guidance (CKS: Impetigo), most cases of non-bullous impetigo resolve within seven to ten days of starting appropriate antibiotic treatment.

Preventing Impetigo

• Wash hands frequently, especially after touching sores
• Do not share towels, flannels, or bedding with the affected person
• Keep sores clean and covered where possible
• Children can return to school or nursery 48 hours after antibiotic treatment has started, or once sores have crusted and healed

Finding a Pharmacy That Offers This Service

Almost all community pharmacies in England participate in the NHS Pharmacy First service. You can search for your nearest pharmacy using PharmSee's pharmacy finder, which lists over 13,000 community pharmacies across England.

For those who prefer to plan ahead, PharmSee's location tool shows how many pharmacies are within walking distance of any English postcode.

Sources: NHS England Pharmacy First service specification; NICE Clinical Knowledge Summary — Impetigo (last updated 2024); NHS.uk — Impetigo.