Impetigo is a common, superficial, bacterial infection of the skin characterized 
by an inflamed and infected epidermis. The rarer variant, bullous impetigo, is 
characterized by fragile fluid-filled vesicles and flaccid blisters and is 
invariably caused by pathogenic strains of Staphylococcus aureus. Bullous 
impetigo is at the mild end of a spectrum of blistering skin diseases caused by 
a staphylococcal exfoliative toxin that, at the other extreme, is represented by 
widespread painful blistering and superficial denudation (the staphylococcal 
scalded skin syndrome). In bullous impetigo, the exfoliative toxins are 
restricted to the area of infection, and bacteria can be cultured from the 
blister contents. In staphylococcal scalded skin syndrome the exfoliative toxins 
are spread hematogenously from a localized source causing widespread epidermal 
damage at distant sites. Both occur more commonly in children under 5 years of 
age and particularly in neonates. It is important to swab the skin for 
bacteriological confirmation and antibiotic sensitivities and, in the case of 
staphylococcal scalded skin syndrome, to identify the primary focus of 
infection. Topical therapy should constitute either fusidic acid (Fucidin, Leo 
Pharma Ltd) as a first-line treatment, or mupirocin (Bactroban, GlaxoSmithKline) 
in proven cases of bacterial resistance. First-line systemic therapy is oral or 
intravenous flucloxacillin (Floxapen, GlaxoSmithKline). Nasal swabs from the 
patient and immediate relatives should be performed to identify asymptomatic 
nasal carriers of Staphylococcus aureus. In the case of outbreaks on wards and 
in nurseries, healthcare professionals should also be swabbed.