Staphylococcal Scalded Skin Syndrome

Key Points
Condition results in red blistering skin that looks like a burn or a scald.
Condition is caused by toxins from staph bacterial infection.
Condition occurs mostly in children under the age of 5, particularly newborns.

Staphylococcal scaled skin syndrome (SSSS) is an illness characterized by red blistering skin that looks like a burn or a scald. SSSS is caused by the release of toxins from toxic strains of Staphylococcus aureus. The toxins cause skin molecules to come unstuck from one another. SSSS has also been called Ritter’s disease or Lyell’s disease when it appears in newborns or young infants.

SSSS occurs mostly in children younger than 5 years, particularly newborns. Lifelong protective antibodies against staph toxins are usually acquired during childhood which makes SSSS much less common in older children and adults. Lack of specific immunity to the toxins and an underdeveloped kidney flushing system lead to infection in infancy.

Immuno-deficient individuals and individuals with kidney failure, regardless of age, may also be at risk of SSSS.
SSSS starts from a staphylococcal infection. Outbreaks of SSSS often occur in childcare facilities. An adult carrier of staphylococcus aureus introduces the bacteria into the nursery. Staph bacteria is common and can live on skin with no adverse symptoms in the carrier. SSSS usually starts with fever, irritability and widespread redness of the skin. Within 24-48 hours fluid-filled blisters form, which rupture easily, leaving an area that looks like a burn. Tissue paper-like wrinkling of the skin is followed by the appearance of large fluid-filled blisters in the armpits, groin and body orifices such as the nose and ears. The rash spreads to other parts of the body including the arms, legs and trunk. In newborns, lesions are often found in the diaper area or around the umbilical cord. The top layer of skin begins peeling off in sheets, leaving exposed a moist, red and tender area. Other symptoms may include tender and painful areas around the infection site, weakness, and dehydration.

Differential Diagnosis (Other conditions with similar appearance)
Kawasaki disease
Scarlet Fever
Toxic shock syndrome

Diagnosis
Key Points
Diagnosis is often determined from history and physical examination.
Biopsy of infected area tissue and bacterial cultures are also useful methods.

Diagnosis of SSSS is often determined from history and physical examination. The diagnosis may be confirmed with a biopsy — taking a tissue sample of the infected area and examining it under a microscope — and bacterial culture.

Treatment
Key Points
Treatment usually requires hospitalization so IV Antibiotics can be administered.
*Most other treatments are supportive to treat fever, pain, skin damage and fluid levels.

Treatment usually requires hospitalization, as intravenous Antibiotics are generally necessary. Depending on response to treatment, oral Antibiotics can be substituted within several days. The patient may be discharged from hospital to continue treatment at home.

Other supportive treatments include paracetamol for fever and pain, maintenance of fluid and electrolyte levels, and skin care. Although the outward signs of SSSS look bad, children generally recover well and healing is usually complete within 5-7 days of starting treatment.