Ineligible patients

Pharmacy teams may find they need to advise patients who aren’t eligible for the Pharmacy First impetigo service because they have bullous impetigo or other skin conditions, by giving self care and over-the-counter (OTC) advice and product recommendations.

Impetigo can look similar to other skin conditions. For example:

• Blisters on the lips or around the mouth could be cold sores. Pharmacy teams can recommend creams to ease pain and irritation, antiviral creams to speed up healing time, or cold sore patches to protect the skin while it heals
• Itchy, dry, cracked or sore skin could be caused by atopic eczema. Emollients can be applied directly to the skin to reduce water loss and covering it with a protective film can help
• Itchy blisters could be shingles or chickenpox, and pharmacy staff can advise the customer to speak to the pharmacist about this, as they may be eligible for the Pharmacy First shingles service.

Non-bullous impetigo – treatable under the Pharmacy First service – is the more common impetigo condition and usually has more manageable symptoms. However, pharmacy teams may still see patients with bullous impetigo, which is less common but can be more painful with severe side effects.

The obvious symptom of bullous impetigo is large, fragile blisters which are usually seen between the waist and neck or on the limbs but can occur across the entire body. The blisters can spread and then after a few days burst to produce a yellow crust which dries before the blisters heal. The blisters themselves might be painful and the area around them can be itchy. In addition, people with bullous impetigo are more likely to have a high temperature or swollen glands.

Pharmacists will refer a person with bullous impetigo to hospital if they suspect a serious complication of impetigo, such as a deep soft tissue infection, or sepsis, or if the person is immunosuppressed and the infection is widespread.