Impetigo & Staph Skin Infections in Children — Medicaid (QUEST) Accepted

Impetigo is one of the most common skin infections in childhood — those honey-colored, crusty sores that seem to appear overnight and spread with scratching. It looks worse than it usually is, and it responds well to treatment. On our islands there is one extra wrinkle worth knowing, which we cover below.

What impetigo is

Impetigo is a superficial bacterial skin infection, most often caused by Staphylococcus aureus (staph) or group A Streptococcus (strep). The Centers for Disease Control and Prevention notes it is most common in children 2 through 5 years old. It typically starts as red or pimple-like sores, often on the face, arms, or legs, that fill with fluid, break open, and dry into a thick, golden crust. The sores itch, and scratching spreads them to new areas and to other children.

A note for Hawaiʻi families: staph and MRSA

Hawaiʻi has notably high rates of skin and soft-tissue infections caused by Staphylococcus aureus, including MRSA (methicillin-resistant staph) — a strain resistant to some common antibiotics. The CDC recognizes MRSA as an increasing cause of impetigo. Practically, this means we don’t assume every skin infection will respond to the usual first antibiotic; when a sore isn’t improving or looks like a boil or abscess, we consider staph, sometimes send a culture, and choose the antibiotic accordingly. This is where local knowledge matters.

How we approach it at Ohana Care Clinic

For a small patch, impetigo is often treated with a prescription antibiotic ointment; when it is more widespread or not responding, an oral antibiotic is used, per CDC guidance. Gentle washing, keeping the area covered, trimming fingernails, and not sharing towels all slow the spread. We practice mālama — careful stewardship of antibiotics — using them when they help and matching the medicine to the likely bacteria rather than guessing. Children can usually return to school 24 hours after starting effective antibiotics and once sores are covered.

Getting care by telehealth

Most of our care at Ohana Care Clinic happens by secure video across Hawaiʻi. A new primary-care or pediatric patient is seen in person for the first visit at our Hilo clinic; after that, many follow-ups and quick questions work well by video. When your keiki is sick, a video visit can often tell us whether they need to be seen in person, saving you a drive when it isn’t needed.

When to get help now

Call 911 or go to the nearest emergency room if your child is struggling to breathe, turning blue around the lips, unresponsive, severely dehydrated, or you believe this is a life-threatening emergency. When in doubt, call us at (808) 867-8002 or use our symptom checker for after-hours guidance on whether your child needs to be seen.

Medically reviewed by Donna Leonard, MSN, APRN, FNP-C, pediatric nurse practitioner, and George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP, President & Owner of Ohana Care Clinic.
Date published: July 2, 2026 · Last reviewed: July 2026 · Citations verified: July 2026

This article is general health education from Ohana Care Clinic, reviewed by Donna Leonard, MSN, APRN, FNP-C, and George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP. It is not a substitute for a personal evaluation by a qualified clinician who knows your child’s situation, and reading it does not create a provider–patient relationship. If you think your child may have a medical condition, reach out to us or another licensed provider. In an emergency, call 911.

References

Centers for Disease Control and Prevention. (2024). Clinical guidance for group A streptococcal impetigo. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/impetigo.html

Centers for Disease Control and Prevention. (2024). About impetigo. https://www.cdc.gov/group-a-strep/about/impetigo.html