Staphylococcal scalded skin syndrome (SSSS) is an infection that causes inflammation and shedding, or peeling, of the skin. Bacteria called Staphylococcus aureus cause the infection.
Certain types of staphylococcal bacteria release a toxin that causes redness and peeling of the surface skin. A mild infection with these bacteria usually starts in a small area of the skin. However, the toxin that is released can get into the bloodstream and affect skin all over the body. Staphylococcal scalded skin syndrome usually occurs in infants and young children but is sometimes seen in adults.
Staphylococcal scalded skin syndrome usually progresses in a predictable way. The infection starts out as a small rash, usually around the diaper area or umbilicus (navel) in babies. In an older person, the infection usually starts on the face. Within 24 hours, mild flu-like symptoms, such as fever and malaise, start to occur.
The area around the rash begins to get red and painful. The rash may spread all around the body. Large blisters then form in affected areas of the skin. These blisters break easily and the skin peels off when touched, often in large sheets.
Within 48 hours, the person may become very ill, with chills and high fever. The surface skin begins to fall off on its own, usually all over the body. Dehydration or salt imbalances can result from large amounts of fluid that weep or ooze out of the damaged skin.
Staphylococcal scalded skin syndrome is caused by an infection with staphylococcal bacteria. Children less than 5 years old are at the highest risk. Adults with weakened immune systems and kidney failure also have a higher risk.
Most cases of staphylococcal scalded skin syndrome cannot be prevented. Frequent hand washing can help stop the spread of this infection and prevent some cases. The infection can be spread between infants, or from the hands of a caregiver, which can cause outbreaks in a day care setting or infant nursery.
The diagnosis of staphylococcal scalded skin syndrome is based on the history and physical exam. Culture samples are usually taken from the skin and inside of the nose. A soft swab is used to wipe these areas. The swab is then put in a container in which the bacteria are allowed to grow.
If bacteria grow, they can be identified. The diagnosis of SSSS is often confirmed with a skin biopsy. This involves scraping or removing a small piece of skin and examining it under a microscope.
With treatment, most children recover within 2 weeks and have no long-term effects from staphylococcal scalded skin syndrome. The skin usually grows back quickly. In some cases, severe dehydration, salt imbalances, and serious blood infections known as sepsis can occur. Rarely, death may result from these complications, more often in adults than children.
Staphylococcal scalded skin syndrome can be spread from person to person by contact with the infected skin. Those who handle infected infants and children may get the bacteria on their hands and spread it to others. Caregivers may be tested for the bacteria by swabbing the inside of the nose. This can identify carriers of the bacteria and help prevent spread of the infection.
Treatment of staphylococcal scalded skin syndrome involves antibiotics and skin care. The antibiotics can sometimes be given as a pill, but are usually given through an intravenous line (IV). An IV is a thin tube inserted through the skin and into a vein, usually in the hand or forearm. The areas of damaged skin must be protected from infection. Antibiotic creams or gels may need to be applied, as well as bandages or dressings. The child may need to be isolated from other children for a brief time to prevent spread of the infection to others. Dehydration and salt imbalances can be treated with fluids and salt given through an IV if needed.
Antibiotics may cause allergic reactions, stomach upset, or other side effects.
Most children with staphylococcal scalded skin syndrome recover completely within a week or two. If treatment is not successful, death may occur. This is rare in children, but more common in adults with weakened immune systems.
The skin of someone with scalded skin syndrome is monitored closely for any signs of new infection. Blood tests may be used to monitor the fluid and salt balance. Any new or worsening symptoms should be reported to the healthcare professional.
Harrison's Principles of Internal Medicine, 1998, Fauci et al.
The Merck Manual, 1995, Berkow et al.