Hydrogen Peroxide Cream
Hydrogen peroxide 1% cream (brand Crystacide) is a topical antiseptic. NICE NG153 (2020) recommends considering it first for localised non-bullous Impetigo in people who are not systemically unwell, applied two or three times a day for 5 days. This keeps topical antibiotics such as Fusidic Acid and Mupirocin in reserve. NICE found no evidence for other antiseptics in impetigo. If peroxide is unsuitable (for example near the eyes) or does not work, NICE moves to fusidic acid. The SmPC says the cream kills both Gram-positive and Gram-negative bacteria, and “there are no known pathogenic bacteria or fungi that develop resistance to hydrogen peroxide”. That is the stewardship case for using it first (Antimicrobial Resistance).
Hydrogen Peroxide Cream [treats] Impetigo Hydrogen Peroxide Cream [precedes] Fusidic Acid Hydrogen Peroxide Cream [prevents] Antimicrobial Resistance
Use in toddlers. The SmPC covers “adults, elderly and children” at 2–3 times daily, for no more than 3 weeks (NICE uses 5 days). Avoid the eyes. Do not use it on large or deep wounds or on healthy skin. It can cause brief burning and bleaches fabric, and an opened tube lasts 28 days. It also contains salicylic acid (“a mild irritant and can cause dermatitis”) and propylene glycol, both relevant to inflamed eczema skin. Under NHS England’s Pharmacy First protocol (v1.1, 2025), pharmacists can supply it from age 1. Use at age 1 is off-label but NICE-supported. The protocol excludes children under 1, those with a “currently uncontrolled episode of eczema”, recurrent impetigo (2 or more episodes in a year), 4 or more lesions, bullous impetigo and eczema herpeticum. A toddler whose eczema is flaring when impetigo appears should therefore see the GP rather than the pharmacist. NHS says impetigo stops being contagious 48 hours after starting the cream (see the nursery-exclusion conflict on Impetigo).
Pharmacy First [regulates] Hydrogen Peroxide Cream Atopic Dermatitis [relates] Hydrogen Peroxide Cream
Not an eczema treatment. NICE NG190 does not mention hydrogen peroxide for Infected Eczema. Its use on widely broken eczematous toddler skin is untested in these sources. The SmPC warning against large wounds and the Pharmacy First exclusion of uncontrolled eczema both point towards caution there. It is not a substitute for Bleach Baths or for steroid and emollient control of the eczema itself.
NICE NG190 [relates] Hydrogen Peroxide Cream
Connections
- Impetigo — first-line for localised non-bullous impetigo, source: NICE NG153
- Fusidic Acid — used before topical antibiotics, source: NICE NG153
- Mupirocin — antibiotic kept in reserve, source: NICE NG153
- Antimicrobial Resistance — no known resistance; stewardship rationale, source: Crystacide SmPC 2025
- Pharmacy First — pharmacist supply from age 1; excludes uncontrolled eczema, source: NHS England protocol 2025
- NICE NG190 — not listed for infected eczema, source: NICE 2021
- Infected Eczema — untested on broken eczematous skin, source: NICE NG190; SmPC