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                 Staphylococcal Scalded Skin Syndrome

What is Staphylococcal Scalded Skin Syndrome?

• Staphylococcal scalded skin syndrome (SSSS) is an illness most common in children and neonates.
  
  
• SSSS is characterised by red blistering skin that looks like a sunburn.
  
  
• Most children who get SSSS are younger than 2 years, and almost all are younger than 6 years.
  
  
• SSSS is caused by the release of a toxin from the bacteria Staphylococcus aureus. 

Who is at risk of SSSS?

• Lifelong protective antibodies against staphylococcal toxins are usually acquired during childhood which makes SSSS much less common in older children and adults. 
  
  
• Immunocompromised individuals and individuals with kidney failure, regardless of age, may also be at risk of SSSS.

How do you get SSSS?

• SSSS starts from a localized staphylococcal infection of the skin (e.g., impetigo - see photos), throat, nose, eye (e.g., conjunctivitis), or umbilicus.
  
  
• The bacteria release a toxin that enters the bloodstream which then leads to the redenning and peeling of the skin.
  
  
• The time from the primary infection to the skin findings may take just hours to days.

What are the signs and symptoms of Staphylococcal Scalded Skin Syndrome?

• SSSS usually starts with fever, irritability, decreased activity and widespread redness of the skin which resembles a sunburn (see photo called Staphylococcal Scalded Skin Syndrome).
  
  
• The involved skin is tender (in contrast to strep scarlet fever which is nontender).
  
  
• Within 1 - 3 days fluid-filled blisters form in the armpits, groin and body orifices such as the nose and ears. These blisters rupture soon after formation.
  
  
• Crusting around the mouth, nose and eyes sometimes occurs (see photo called Staphylococcal Scalded Skin Syndrome 2).
  
  
• Tissue paper-like wrinkling of the skin then occurs and the top layer of skin begins peeling off in sheets, leaving exposed a moist, red and tender area  (see photo called Staphylococcal Scalded Skin Syndrome 3).
   
  

How is Staphylococcal Scalded Skin Syndrome fever diagnosed?

• Diagnosis of SSSS is often suspected based on a child’s history and physical examination.
  
  
• The diagnosis may be confirmed with the detection of Staphylococcus aureus from a primary infection site and possibly from the blood.

What is the treatment of Staphylococcal Scalded Skin Syndrome?

• Treatment usually requires hospitalization, as intravenous antibiotics are generally necessary to remove the staphylococcal infection.
  
  
• Depending on response to treatment, oral antibiotics may be substituted within 2-3 days.
  
  
• Tylenol or Motrin as needed for fever and pain.
  
  
• Fluid hydration is important.
  
  
• Skin care similar to the care for burns

What are the complications from SSSS?

• Although the outward signs of SSSS look bad, children generally recover well and healing is usually complete within 5-7 days of starting treatment.
  
  
• SSSS has a broad spectrum of severity: in some cases the child appears very ill, is in a lot of pain and is dehydrated and in other cases the signs and symptoms are mild.
  
  
• SSSS usually follows a benign course when diagnosed and treated appropriately.
  
  
• However, if left untreated or treatment is unsuccessful, severe infections such as cellulitis and pneumonia may develop.

 When should I call my pediatrician concerning an illness that resembles SSSS?

• It is best to call for specific instructions when you first suspect that your child has an illness resembling Staphylococcal Scalded Skin Syndrome.
  
  
• Early diagnosis will insure the appropriate treatment for your child which shorten the length of illness and possibly avoid any complications.
  
  
• You should also call your doctor if your child has had fever for more than two to three days, if your child looks sicker or if he/she is becoming dehydrated.
  

How can Staphylococcal Scalded Skin Syndrome be prevented?

• If there is an outbreak of SSSS in either a neonatal care unit or childcare facility, the possibility of a staphylococcal carrier in the vicinity should be investigated.
  
  
• Identification of the healthcare worker, childcare worker, parent or visitor colonised or infected with Staphylococcus aureus is key to managing the problem.
  
  
• Frequent hand washing is recommended to decrease the chance of becoming infected. Click on how to prevent infection for more details.