Staphylococcal Scaled Skin Syndrome

Patient Education

What is staphylococcal scalded skin syndrome?

Staphylococcal scalded skin syndrome (SSSS) has also been called Ritter's disease or Lyell's disease when it appears in newborns or young infants. SSSS is an illness characterized by red blistering skin that looks like a burn or scalds, hence its name staphylococcal scalded skin syndrome. SSSS is caused by the release of two exotoxins (epidermolytic toxins A and B) from toxigenic strains of the bacteria Staphylococcus aureus. Desmosomes are the part of the skin cell responsible for adhering to the adjacent skin cell. The toxins bind to a molecule within the desmosome called Desmoglein 1 and break it up so the skin cells become unstuck.

Who is at risk of staphylococcal scalded skin syndrome?

SSSS occurs mostly in children younger than 5 years, particularly neonates (newborn babies). Lifelong protective antibodies against staphylococcal exotoxins 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 immature renal clearance system (toxins are primarily cleared from the body through the kidneys) make neonates the most at risk. Immunocompromised individuals and individuals with renal failure, regardless of age, may also be at risk of SSSS.

How do you get staphylococcal scalded skin syndrome?

SSSS starts from a localized staphylococcal infection that is a producer of the two causative exotoxins (epidermolytic toxins A and B). Outbreaks of SSSS often occur in childcare facilities. An asymptomatic adult carrier of Staphylococcus aureus introduces the bacteria into the nursery. About 15-40% of healthy humans are carriers of Staphylococcus aureus, that is, they have the bacteria on their skin without any sign of infection or disease (colonization). However, staphylococcal skin infections are seen commonly in infants and younger children, thus an obvious increased risk of SSSS. Staphylococcus aureus is also commonly found in infections of the throat, ears, and eyes.

What are the signs and symptoms of staphylococcal scalded skin syndrome?

SSSS usually starts with fever, irritability and widespread redness of the skin. Within 24-48 hour’s fluid-filled blisters form. These rupture easily, leaving an area that looks like a burn. Characteristics of the rash include: Tissue paper-like wrinkling of the skin is followed by the appearance of large fluid-filled blisters (bullae) in the armpits, groin and body orifices such as the nose and ears. 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 injection site, weakness, and dehydration.

How is staphylococcal scalded skin syndrome fever diagnosed?

The diagnosis of SSSS is often suspected from the characteristic 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 (colonizing the sample to identify the causative organism).

What is the treatment of staphylococcal scalded skin syndrome?

Treatment usually requires hospitalization, as intravenous antibiotics are generally necessary to eradicate the staphylococcal infection. A penicillinase-resistant, anti-staphylococcal antibiotic such as flucloxacillin is used. Depending on the response to treatment, oral antibiotics can be substituted within several days. The patient may be discharged from the hospital to continue treatment at home. Other supportive treatments include Paracetamol when necessary for fever and pain. Maintaining fluid and electrolyte intake. Skincare (the skin is often very fragile)