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Skin infections in children

Key points about skin infections in children

A skin infection occurs when germs penetrate the skin and spread. When this happens, it can cause pain, swelling and redness.
A skin infection may be mild or serious.
Read on to learn how to recognise the early signs of different types of skin infections and what to do for each one.

Small girl at the playground scratching her head

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Your skin is the largest organ of your body. Its function is to protect your body from infection. Sometimes the skin itself becomes infected.

Skin infections are caused by a wide variety of germs, such as bacteria, viruses and fungus. These can enter the body through a break in your skin, such as a cut or a scratch. Symptoms can vary from mild to serious.

Treatment depends on the type of infection and how serious it is. Some can be treated by good hygiene measures (such as cleaning the area with warm water and covering it with a plaster or bandage) or over-the-counter medicines (such as anti-fungal creams), whereas other infections may need medical attention (such as antibiotics for cellulitis).

Skin infections are different from rashes. A rash is an area of swollen or irritated skin. While rashes can be symptoms of some skin infections, a person with a rash does not necessarily have an infection. Learn more about rashes in children

Take your child to a doctor or nurse if your child has a sore or wound that:

is bigger than the size of a 10 cent coin (about 1.5 cm)
is getting bigger
has pus
has red streaks coming from it
is not getting better after 2 days
is close to your eye
won’t stop bleeding.

If skin infections are not treated, they can lead to other serious health problems. Your child may end up in hospital with a serious skin infection or blood poisoning which can hurt their lungs, kidneys, joints, muscles, bones and brain.

The following are some common skin infections found in children.

boils and abscesses
cellulitis
cuts, scratches and grazes
eczema
impetigo
insect bites
ringworm
scabies
fungal skin infections

*Your child’s skin may not look exactly like the pictures on this page. Ask your public health nurse, school nurse or doctor what is wrong with your child’s skin if you are not sure.

	Boils and abscesses
Early signs	Tender red bump or pimple with red skin around it. Caused by a build-up of pus under the skin. Can have white or yellow pus in the centre. Might be itchy or a bit painful. A large boil is called an abscess (you say, ab-ses).
What to do	Go to the doctor immediately if a boil is near your child’s eye. Check and clean boils every day. Soak the boil in warm water for 20 minutes or cover with a towel soaked in warm water. If a boil bursts, wipe away pus and blood with a tissue. Wash and dry hands before and after touching the boil.
If it gets worse	Go to the doctor if any of these things happen: the boil gets larger or more painful more boils appear the boil lasts more than 1 week red streaks start to appear on the skin around the boil your child gets boils often your child seems unwell or has a fever.
How is it spread?	Pus or blood from a boil getting on to the skin can cause more boils.
Time off from kura or school?	While your child is feeling unwell. If your child is feeling well they can go to school or kura but keep boils covered with plasters or dressing.
Learn more about boils.

	Cellulitis (you say, sell-you-ly-tis)
Early signs	Skin will look red and feel warm and painful to touch. There may be pus or fluid leaking from the skin. Any broken or bruised skin can get infected with cellulitis.
What to do	Go to the doctor if the skin is painful, redness and swelling is bigger than a 10 cent piece or near the eye, or there are red lines in your skin spreading out from the centre of the infection. Check and clean every day. Wash the red skin with warm water, or soak in a bath. Cover with a clean cloth or plaster if leaking. Give your child paracetamol if they are in pain. Wash and dry hands before and after touching the infected area.
If it gets worse	Go back to the doctor if any of these things happen: infected area gets larger or deeper your child seems more unwell or has a fever. This is urgent as the infection may travel to your child’s blood. Your child may need blood tests and antibiotics.
How is it spread?	Pus, blood or other fluid from the infection gets on to broken skin.
Time off from kura or school?	For at least 1 day after treatment has started. Or ask your doctor or public health nurse.
Learn more about cellulitis.

	Infected cuts, scratches and grazes
Early signs	Broken skin with some blood.
What to do	Clean and check the broken skin daily. Wash with warm water. Cover with a plaster or bandage. Try to use things that won’t stick to the wound. Most cuts, scratches and grazes will heal by themselves after a few days. Antiseptics and antibiotics are not usually needed. Go to the doctor if it is a deep cut or it won’t stop bleeding. Your child may need stitches.
If it gets worse	Go to the doctor if any of these things happen: the cut, scratch or graze is near the eye the broken skin becomes redder, swollen or painful there is pus around the broken skin red lines spread out from the broken skin your child feels unwell or has a fever This may be cellulitis and the infection may travel to your child’s blood. Your child may need blood tests and antibiotics.
How is it spread?	Infection is spread if pus, blood or other fluid gets on to broken skin.
Time off from kura or school?	If infected, at least 1 day after treatment has started. Or ask your doctor or public health nurse.
Learn more about cuts and grazes.

	Infected eczema (you say, ex–ma) Also called dermatitis (you say, der-ma-ty-tis)
Early signs	Dry, inflamed, itchy, red, cracked and rough patches of skin. Commonly found behind your knees and on your arms, hands, neck and face.
What to do	Keep the eczema clean. Use soap-free cleansers instead of soap. Moisturise if the skin is dry. This may be many times a day. Use an emollient cream such as fatty cream or non-ionic cream. Keep your child’s nails short and clean. Try to stop them scratching the eczema. See a doctor for medicated creams if your child is waking at night or missing school because of eczema.
If it gets worse	Go to the doctor if any of these things happen: areas of skin start swelling and become more painful rash becomes weepy, red or blistered. This means the eczema has become infected. It could be cellulitis. Do not do anything to dry out the skin as this will make the eczema worse.
How is it spread?	Eczema is not contagious.
Time off from kura or school?	If your child feels well they can go to school or kura.
Learn more about eczema.

	Impetigo (you say, im– pa–ty–go) Also called school sores
Early signs	Blisters on exposed parts of body, such as hands, legs and face. Blisters burst and turn into a sore with a yellow crust which gets bigger each day. The sores are itchy. Very contagious.
What to do	Go to the doctor for antibiotic tablets or a cream. Check and wash sores every day. Use the cream as told by your doctor or nurse. Cover sores with a clean cloth or plaster. Keep your child’s nails short and clean. Try to stop them scratching the sores. Wash and dry hands before and after touching the sores.
If it gets worse	Go to the doctor if any of these things happen: sores are near the eye sores last more than 1–2 weeks sores become red, swollen and have pus your child has a fever. This is urgent, the infection may travel to your child’s blood. Your child may need blood tests and antibiotics.
How is it spread?	Pus, blood or other fluid from the sores touching other skin. It is very easy to catch and spread.
Time off from kura or school?	For at least 1 day after treatment has started. Ask your doctor or public health nurse.
Learn more about impetigo (school sores).

	Insect bites
Early signs	Red bump. There may be a blister in the middle. Very itchy. Sometimes painful (especially spider bites).
What to do	Check and clean bites every day. Wash the bite with cool water. Stop scratching. Keep your child’s nails short and clean. Try to stop them scratching the bites. Use something to stop the itching such as ice, calamine lotion or aloe vera.
If it gets worse	Go to the doctor if any of these things happen: the bumps last more than 2 weeks the red, swollen area keeps getting bigger or more painful there is pus. The swelling could be poison from the insect or a serious skin infection such as cellulitis.
How is it spread?	Insects such as mosquitos, fleas or spiders.
Time off from kura or school?	If your child feels well they can go to school or kura.
Learn more about insect bites.

	Ringworm (fungal skin infection)
Early signs	Flat, ring-shaped rash around normal-looking skin. Caused by a fungus, not a worm.
What to do	See your doctor if the ringworm is on your child’s scalp. This may cause painful red patches and hair loss. Your doctor, public health nurse or pharmacist can suggest a cream to use to kill the infection. Check and clean skin every day.
If it gets worse	Go to the doctor if any of these things happen: the ringworm is on the scalp infected area lasts more than 2 weeks skin becomes red, swollen and has pus your child has a fever. These are signs of serious skin infection. Image credit: Ministry of Health NZ
How is it spread?	Ringworm spreads easily through contact with infected skin, clothes or personal items, and floors and showers.
Time off from kura or school?	Until the infection is gone don’t let your child do things where their skin could touch other children.
Learn more about ringworm.

	Scabies (you say, skay-bees)
Early signs	Itchy rash in places such as: the forearm around waist between fingers between buttocks under armpits.
What to do	Go to the doctor or public health nurse to get cream for everyone in the house. Scabies is very contagious so everyone in the house needs to be treated even if you can’t see any rash. Apply cream to everyone, head to toe – including soles of feet. Don’t put cream on or near eyes. Wash all sheets, towels and clothing in hot water.
If it gets worse	Go to the doctor if any of these things happen: rash becomes infected the skin is red, painful, warm, swollen or has pus. This is a serious skin infection. Remember, everyone in the house must be treated for scabies.
How is it spread?	Skin contact with a person with scabies. Sharing sheets, towels and clothes.
Time off from kura or school?	For at least 1 day after treatment has started.
Learn more about scabies.

	Tinea (fungal skin infections)
Early signs	Redness and/or itching. Burning or stinging. A rash that may form blisters or pustules. Raw, inflamed or scaly skin. Common on feet (athlete's foot) and groin (jock itch).
What to do	Use an antifungal cream, lotion, gel or spray from the pharmacy or as prescribed by your doctor. Keep your skin as clean and dry and possible. Wear loose-fitting clothes and underwear that ‘breathes’. Shower or bathe daily, dry thoroughly between your toes and skin folds, and use a hairdryer if necessary. Wash the shower and bath using a bleach-based product every couple of days. Wash socks, towels, bathmats and underwear in very hot water (over 60ºC) and dry them well. Do not share towels, clothing or shoes.
If it gets worse	See your doctor if: the infection becomes severe, long-lasting non-prescription treatments from the pharmacy have not worked the skin is swollen, blistered, crusted or smells unpleasant. Not all skin and nail changes that look like tinea are in fact tinea, so it is important to have them checked if they do not clear up quickly.
How is it spread?	Fungal infections spread easily through contact with infected skin, clothes or personal items. Also from floors and showers
Time off from kura or school?	Until the infection is gone don’t let your child do things where their skin could touch other children.
Learn more about fungal skin infections.

Skin infection topics
Boils and abscesses
Cellulitis | Pokenga kiri
Cuts and grazes
Eczema in children
Impetigo
School sores | Pokenga kiri whēwhē
Insect bites and stings
Ringworm
Scabies | Mate māngeongeo riha

What prescribers need to know

In primary care, many skin infections are relatively minor and do not need to be treated with antibiotics. Management should focus on good skin hygiene measures and a trial of a topical antiseptic.
Do not prescribe topical antibiotics for patients with infected eczema, for wound management, for other skin infections or first-line for impetigo. If antibiotic treatment is required, prescribe an oral medicine
Topical antibiotics may be appropriate as a second-line option for patients with areas of localised impetigo, if first-line management with hygiene measures and topical antiseptics has not resolved the lesions or for Staphylococcus aureus nasal decolonisation
If a topical antibiotic is prescribed, patients should be instructed to use it for no longer than seven days. The practice of saving an unfinished tube as a first-aid measure for household members should be strongly discouraged.