Impetigo is a common bacterial skin infection that sits in the top layer of the skin. It shows up as sores that break open and dry into a golden-yellow crust. It is very contagious, mostly affects children, and clears quickly once it is treated. Eczema is a group of long-term conditions in which the skin barrier leaks moisture and the immune system in the skin overreacts. Atopic dermatitis is the most common kind. The result is skin that is dry, itchy and inflamed, in flares that come and go. It is controlled rather than cured, and most of it responds well to treatment used properly.
The same eight facts on every condition comparison.
It is a bacterial skin infection.
Staphylococcus aureus and group A streptococci are the usual causes.
It has two forms.
Nonbullous impetigo forms crusts; bullous impetigo forms blisters.
Bacteria enter broken skin.
Eczema, scratches and bites are common entry points.
Testing is selective.
Swabs help with recurrent, resistant or unusual cases.
It is a recurring inflammatory condition.
Atopic eczema involves a vulnerable barrier and an itch–scratch cycle.
Several factors reinforce each other.
Dryness, irritants, inflammation and scratching feed one another.
It is not about cleanliness.
Vigorous cleansing can make eczema worse.
Care has two parts.
Emollients protect the barrier, while anti-inflammatory treatment settles active flares.
Non-bullous impetigo Sores with honey-colored crusts; most common.
Bullous impetigo Larger fluid-filled blisters.
Ecthyma Deeper, punched-out ulcers.
Atopic dermatitis Long-term, starts in childhood.
Infant facial eczema Inflamed, rough patches affect the cheeks.
Hand eczema Dry, cracked or blistered hands.
Dyshidrotic eczema Tiny itchy blisters on fingers and palms.
Nummular eczema Coin-shaped patches.
Contact dermatitis Triggered by something touching the skin.
Bacteria infect the superficial skin, often after a small break in the barrier. Shallow sores or blisters can release fluid that dries into a honey-colored crust.
In atopic dermatitis, a less effective skin barrier and overactive immune signals reinforce each other. Water escapes more easily, and itching and scratching can add damage and prolong inflammation.
Eczema often affects the inner elbows and backs of the knees. In adults, the hands, face and neck may also be involved.
Impetigo. Most common in young children, although any age can be affected.
Eczema. Often starts in infancy or childhood, though it can first develop in adulthood.
Impetigo is a skin infection caused by staph or strep bacteria entering through small breaks in the skin.
Eczema comes from a weak skin barrier combined with an overactive immune response. Moisture escapes, irritants get in and the skin becomes itchy and inflamed.
Changes in the filaggrin gene, which helps build the skin barrier, are a major risk. Eczema often runs in families with asthma and hay fever.
Evidence labels come from each condition’s own treatment list.
General antiseptic ointments from the shelf are not the same thing as a prescription antibiotic ointment and usually do not clear impetigo. The main cost of trying them is time: the infection keeps spreading and the child stays off school for longer than they needed to.
The one steroid you can buy without a prescription, and the only step in this routine that treats rather than protects. A thin layer twice a day on the itchy patches, for up to two weeks at a time. Mild enough for the face and the eyelids for a few days, and too mild for skin that has gone thick and leathery.
A spray that lowers the amount of staph sitting on eczema skin, aimed at step four rather than at the inflammation itself. It does not sting, which makes it easier on children than a bleach bath. It is a helper for skin that keeps getting infected, not a treatment for the flare.
Taken at bedtime it helps you sleep through the itch, which is the honest reason to use it. It does not treat the itch of eczema — that comes from immune signals rather than histamine — so a non-drowsy antihistamine in the daytime does very little. Ask your doctor before using one in a young child.
Plain ointment, over damp skin, as the moisturizer rather than beside it. It seals water in rather than adding any. It is the one thing that is safe to put on eyelids as often as you like, and on a weeping flare it is usually the best thing on the shelf.
An old remedy that holds up. It calms itch and helps the barrier, in a cream or in a lukewarm bath. It will not clear a flare, and it is a sensible everyday moisturizer for skin that is calm but easily set off.
A moisturizer with urea in it, for patches that have gone thick and leathery from years of scratching. 10% and above. It stings on raw or weeping skin, so it belongs to the dry, cracked stage rather than the sore one.
The fats that hold the outer wall of the skin together, and the ones eczema skin is short of. A ceramide cream used daily reduces how often flares happen and how much prescription cream you end up needing over a year. It will not clear an active flare on its own — it is the maintenance step, used on calm skin as much as on sore skin.
The usual first choice for a small number of patches, applied three times a day for about five days after the crust has been softened off. For a few sores it works as well as tablets and avoids their side effects. It is also the ointment used inside the nostrils when impetigo keeps coming back and long-term carriage in the nose is the reason.
An equally effective alternative ointment for a few small patches, used three times a day for five to seven days. Which of the two you are given depends mostly on local resistance patterns and what your country prescribes first. Neither is enough on its own once the infection is widespread.
Ozenoxacin cream. A newer antibiotic cream for the crusted form, used twice a day for five days. It is an option where resistance to the older ointments is a problem, and it works against some resistant staph. It is not widely stocked and is usually the more expensive choice.
Triamcinolone. A mid-strength steroid ointment, twice a day for one to two weeks. It is the usual next step when hydrocortisone is not enough. Not for the face, the eyelids or the armpits - the skin there is thin already.
Protopic. An ointment that calms the same immune signal a steroid does, without being one. It does not thin skin, so it suits the eyelids, the face and the folds, and it can be used twice a week to stop flares coming back. Expect stinging for the first week or so.
A low-strength steroid made for thin skin - the face, the eyelids, the folds, and young children. Twice a day for a week or two.
Eucrisa. A steroid-free ointment for mild to moderate eczema, approved down to three months old. It burns on application for some people, which is the main reason it gets abandoned.
Elidel. The gentler cousin of tacrolimus, in a cream rather than an ointment. Suited to mild eczema on the face and the eyelids. It stings less, and it does less.
Opzelura. A newer steroid-free cream that takes the itch down quickly. It is meant for short courses on a limited area of the body, and it carries the warnings that come with the JAK class.
One of the strongest steroids there is, kept for thick, stubborn patches and for palms and soles. Two weeks at a time, then a break. Long stretches thin the skin.
A steroid-free cream applied once a day, approved for eczema down to two years old. It calms the inflammation without thinning skin, and in trials the improvement often held for a while after stopping. Folliculitis — small spots around the hair openings — and headache are the side effects that come up, and it is newer and more expensive than a steroid.
Zoryve. Another steroid-free once-daily cream, approved for eczema down to six years old. It is well tolerated on the face and the folds, and it does not sting the way tacrolimus does in the first week. Like the other newer creams, the barrier is cost and coverage rather than whether it works.
The usual tablets or liquid when the infection is widespread, spreading fast, blistering, or the person feels unwell. A course runs about seven days, and the contagious period ends after roughly the first day of it. Finish the course even once the crusts have gone, because stopping early is one of the common reasons it comes straight back.
Used when there is a penicillin allergy, or when a swab shows resistant staph. It works well against the bacteria that cause impetigo. It upsets the stomach more than the first-choice options and, uncommonly, can cause a serious bowel infection, so any diarrhoea during or shortly after a course is worth reporting.
Reserved for adults and older children when a swab shows resistant staph, and not used in young children or in pregnancy — ask your doctor if either applies. It is a reasonable option for the age group that fits it, but for the usual patient with impetigo, a small child, it is not the drug.
Tablets for severe eczema that has not answered creams — they work fast, often taking the itch down within days. They need blood tests, and the class carries warnings about infection, blood clots and heart problems, so they are prescribed with a proper discussion of who they suit. Usually considered alongside the injections rather than before them.
Works fast on a severe flare, which is what it is for - weeks to months, not years. It raises blood pressure and strains the kidneys, so both are checked while you are taking it.
A weekly tablet for long-running eczema. Cheaper than the injections and slower to work, with blood tests every few months. Ask your doctor about it before trying to conceive, and if you are pregnant or breastfeeding.
Oral steroids clear eczema quickly and it usually returns worse within weeks of stopping. Most dermatologists avoid them for that reason, and use them only to break a severe flare while something slower is started.
A short course when a flare is weeping or carrying golden-yellow crusts, which usually means staph has taken hold. It clears the infection so the eczema treatment can work again. It is not a treatment for eczema itself, and taking it for every flare is how resistance builds, so it is used when there is something to treat.
Dupixent. An injection every two weeks, for eczema that covers a lot of skin and has not answered creams. It is not a steroid and it needs no blood monitoring. Eye irritation is the side effect people actually get.
An injection every two weeks for moderate to severe eczema, blocking one of the same immune signals Dupixent does. It is the usual next thing to try when Dupixent has not worked well enough or has not been tolerated. No blood monitoring, and eye irritation is the side effect to know about, as with Dupixent.
Measured doses of ultraviolet light in a booth, two or three times a week for a couple of months. It works. The cost is time, because it means getting to the office that often.
The same idea as the light booth, aimed at one patch instead of the whole body. Useful when a few stubborn areas are all that is left.
Impetigo moves fast - it appears over days and, treated, clears in about a week. Untreated it usually resolves in around 2 to 3 weeks, but it spreads much further meanwhile, stays contagious throughout, and carries more risk of complications. Ecthyma, the deeper form, takes several weeks and does scar.
Eczema comes in flares - calm skin, then days or weeks of itching and inflammation, then calm. Most people eventually name their own pattern: the season, the stress, the job, the week before a period. Underneath that, it follows a longer arc.
Cellulitis
Occasionally the bacteria get past the top layer and into the deeper tissue. The area around the sores becomes swollen, hot and increasingly painful, with redness or darkening spreading outward into normal skin, and the person often feels unwell with it. It is uncommon and it is treatable, but it needs antibiotic tablets rather than a cream, and it is a same-day problem rather than one to watch overnight.
Ecthyma — the deeper form
When the infection punches through into the layer below, it forms a punched-out ulcer under a thick, hard crust, most often on the lower legs. It is the one form of impetigo that heals slowly and does leave a scar. It is more likely where sores have been picked at, where treatment was delayed, and in people with diabetes or a weakened immune system. It needs antibiotic tablets, not an ointment.
Days off school and spread at home
Most settings ask for about 24 hours of antibiotic treatment before a child returns, with any remaining sores covered, so treating early is what gets them back soonest. The bigger cost is usually at home: without separate towels, bedding and hot washing, it works its way through the other children and sometimes the adults, and each new person starts the clock again.
Impetigo
Bacteria getting into skin that scratching has broken open. It shows as weeping and golden-yellow crusts sitting on top of an eczema patch, and it can turn a settled flare much worse in a day or two. It needs an antibiotic alongside the usual eczema treatment - more moisturizer will not clear it.
Sleep loss, fatigue and low mood
Itch is at its worst at night, so eczema costs sleep - for the person who has it, and often for the rest of the house. Months of broken sleep bring daytime fatigue and poor concentration, and anxiety and depression are more common in people with moderate or severe eczema. It is worth telling your doctor. Treating the eczema properly is usually what fixes the sleep.
Thickened, leathery skin
Months of rubbing and scratching the same patch thicken it into leathery skin with the normal lines cut deeper. Doctors call it lichenification. It itches on its own, and it takes far longer to settle than a fresh flare - stopping the scratching is the only thing that reverses it.
Dark or light marks after a flare
Settled patches often leave flat marks that are darker than the skin around them, and sometimes lighter patches where pigment has dropped out. Neither is a scar, and neither is caused by the treatment. They fade on their own, but over months rather than weeks, and they are more noticeable and longer-lasting on deeper skin tones.
New allergies to products
Broken skin meets far more of whatever is put on it, so people with eczema pick up contact allergies more easily - to preservatives, fragrance, and sometimes to the eczema creams themselves. Suspect it when a treatment that used to work starts to sting or spread the rash. Patch testing is how it is confirmed.
Eye problems
Eyelid eczema and constant rubbing lead to itchy, swollen lids and red, irritated eyes. In severe, long-standing eczema, a change in the shape of the cornea called keratoconus and early cataracts are uncommon but recognized. If the eyes are involved often, it is worth an eye check.
Hand eczema that gets in the way of work
Cracked, sore hands are hard to hide and hard to rest. In wet work - healthcare, food, cleaning, hairdressing, childcare - it can mean time off or a change of job. Treating it early and protecting the hands through the working day is what keeps it from getting that far.
The atopic march in children
Children with eczema are more likely than other children to go on to develop asthma, hay fever and food allergy, often in that order. Doctors call the pattern the atopic march. It is a tendency, not a certainty - most children with eczema do not get all of it.
Seek treatment for suspected impetigo. Spreading redness, fever, marked pain or a newborn with blisters needs prompt assessment.
Seek help for sleep-disrupting itch, recurrent flares or infection. Rapidly worsening painful skin with clustered blisters, fever or eye involvement needs urgent care.
Until about 24 hours after antibiotics start, or until the sores have fully dried and crusted if untreated, which takes far longer. That is why treatment is offered even though it would clear on its own - it cuts the contagious period from a week or more to about a day.
Most settings ask for around 24 hours of antibiotic treatment first, with remaining sores covered. Rules vary between countries, schools and nurseries, so check the policy.
Ordinary impetigo almost never scars, because it sits in the top layer of skin. Flat pink, brown or pale marks fade over weeks to months, more slowly on deeper skin tones. Ecthyma, the deeper ulcerating form, does scar, and picking raises the risk in any form.
Usually eczema that is not fully controlled, which keeps supplying broken skin. Other reasons are scratching from bites or scabies, shared towels and bedding, or long-term Staphylococcus aureus in the nose. Look at those rather than repeat the antibiotic.
Yes, though it is much less common in adults with healthy skin. The risk rises with eczema, a cut, a graze or any other break. Separate towels, handwashing after applying the ointment, and hot washing of bedding reduce the chance.
It depends how much skin is involved. A prescription ointment works as well as tablets for a few patches and avoids the side effects of oral antibiotics. Tablets or liquid are for widespread infection, rapid spread, large blisters, or an unwell child. Make that call with a doctor.
Many children improve a great deal by school age, and more through the teenage years. Complete, permanent clearance happens but is not the rule. What usually remains is dry, easily irritated skin that can flare again later, often on the hands. Treating it well in childhood does not guarantee it goes, but it means fewer flares, less scratching, less thickened skin.
Used as prescribed, yes. The rules are simple - mild strengths on the face, eyelids and skin folds, stronger ones for the body and limbs, and courses that run the length of a flare rather than indefinitely. Thinned skin and stretch marks come from strong steroids on thin skin for months without review. If you are using one more or less continuously, go back and ask about a non-steroid option.
Usually not, and this is a common wrong turn. Food allergy is more common in children with eczema, but because both come from the same atopic tendency, not because food drives the rash. Removing foods rarely clears eczema, and long elimination diets can cause nutritional problems and even make a true allergy more likely. A clear, repeatable reaction within a couple of hours is worth investigating. A vague suspicion is not.
Several things line up after dark. Body temperature rises in the evening, and heat triggers itch directly. The distractions that kept you from noticing it are gone. Cortisol, which damps inflammation, is at its lowest overnight. And scratching in your sleep is unconscious, so damage piles up unchecked. A cooler bedroom, moisturizer right before bed, short nails and cotton layers help more than they sound.
Not always. Facial skin, eyelid skin especially, is much thinner and absorbs more of what you put on it. A steroid strong enough for your shins can thin the skin around your eyes within weeks. Face and eyelid eczema is treated with a mild steroid for a short stretch, or a non-steroid cream that can be used long term. Ask before moving a body prescription to your face.
Yes. This is the single habit that separates people who flare four times a year from people who flare monthly. Skin that looks normal in eczema is still leaky - the barrier defect is there whether or not there is a rash. Daily moisturizer on calm skin keeps the next flare further off and smaller. It is maintenance, not first aid.
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