Patient information · Dermatology and family health
Impetigo, scabies and head lice
three contagious problems, three different rules
These three get grouped together because they spread within families and schools, and because they carry more embarrassment than they deserve. None reflects poor hygiene. Each has a specific treatment, and each fails for a specific and avoidable reason.
Seek medical assessment urgently if there is
- spreading redness, swelling and heat around an impetigo patch, or a fever
- impetigo in a newborn baby, or widespread blistering
- scabies with thick crusted plaques, particularly in someone elderly or immunosuppressed — this is highly contagious and needs specialist treatment
- any of these with a weakened immune system
- skin that is hot, exquisitely painful and rapidly worsening
Impetigo can occasionally lead to cellulitis or deeper infection. Crusted (Norwegian) scabies carries thousands of mites rather than a dozen and spreads through households and care homes rapidly. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
Impetigo
A bacterial skin infection producing golden-yellow crusts, usually around the nose and mouth or on the hands. It often starts in broken skin — a scratch, an insect bite, cold sores or eczema.
- Localised impetigo is now treated first with hydrogen peroxide 1% cream rather than an antibiotic, to reduce resistance. An antibiotic cream is used if that does not work.
- Widespread or bullous impetigo, or someone systemically unwell, needs oral antibiotics.
- Stay off school or work until the sores have crusted and dried, or for 48 hours after starting antibiotic treatment.
- Wash the crusts gently with soap and water; do not pick them.
- Separate towels, flannels and bedding; wash hands after touching the area; keep fingernails short.
- Treat any underlying eczema, which is the usual reason it keeps coming back.
Scabies
A mite that burrows into the skin, causing intense itching that is far worse at night. Look for a rash between the fingers, on the wrists, elbows, armpits, waistband, buttocks and genitals; in babies and young children the palms, soles, face and scalp are involved too.
- Treat every household member and any sexual contact on the same day, whether or not they itch. Symptoms take up to eight weeks to appear, so untreated contacts reinfect everyone.
- Apply the treatment cream or lotion to the entire body from the jawline down — including between fingers and toes, under nails, the genitals and the soles. Include the scalp and face in babies, the elderly and the immunosuppressed.
- Apply to cool, dry skin, not after a hot bath, and leave on for the full time stated — usually 8 to 12 hours. Reapply to hands if you wash them.
- Repeat the whole process after seven days. This second application is not optional; the first does not kill eggs.
- Wash clothing, towels and bedding at 60°C on the treatment day. Anything that cannot be washed can be sealed in a bag for 72 hours.
The itch continues after the mites are dead
Itching commonly persists for two to four weeks, sometimes six, after successful treatment. This is an allergic reaction to dead mites and their debris — not treatment failure, and not reinfestation. Repeating the treatment repeatedly out of frustration causes skin irritation that makes matters worse. Use an emollient, an antihistamine at night, and mild steroid cream if needed. Come back if new burrows appear, or if the itch is still worsening after six weeks.
Head lice
- Only treat if you see a living, moving louse. Itching alone, or finding empty egg cases, is not enough — nits stay stuck to the hair long after treatment and do not indicate active infestation.
- Wet combing with conditioner and a fine detection comb, every three to four days for two weeks, is effective and free of chemicals.
- Dimeticone lotions physically smother lice and are preferred over insecticides, to which lice are widely resistant. Repeat after seven days.
- Check the rest of the household and treat only those with live lice.
- No need to keep a child off school, and no need to wash bedding or clothing specially — lice die within hours off the head.
- Lice prefer clean hair as readily as dirty. It says nothing about your household.
Book an appointment if you are unsure of the diagnosis, treatment has not worked, a rash is spreading or infected, or you need a whole household assessing and prescribing for at once. Our dermatology and GP teams see these seven days a week, discreetly and without judgement.
Seen today, whole household if needed
Appointments seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.