Red flags

The following require immediate onward referral:

• Eczema herpeticum – a dermatological emergency that needs urgent referral to A&E
• Worsening symptoms despite treatment
• Presence of severe pain
• Rapid spread of infection
• Signs of systemic infection, such as fever and feeling unwell
• The development of potential complications, such as cellulitis.⁴

Someone should be referred immediately if there is systemic upset, the person is immunocompromised, or the impetigo is wide-spread or bullous. An urgent referral to a GP may be necessary for oral antibiotics.⁴