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Staphylococcal Scalded Skin Syndrome

A severe skin disorder, staphylococcal scalded skin syndrome (SSSS) is marked by epidermal erythema, peeling, and superficial necrosis that give the skin a scalded appearance. SSSS is most prevalent in infants ages 1 to 3 months but may develop in children; it's rare in adults.

This disease follows a consistent pattern of progression, and most patients recover fully. Mortality is 2% to 3%, with death usually resulting from complications of fluid and electrolyte loss, sepsis, and involvement of other body systems.

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.

Causes of Staphylococcal Scalded Skin Syndrome

The causative organism in SSSS is Group 2 Staphylococcus aureus, primarily phage type 7 I. Predisposing factors may include impaired immunity and renal insufficiency - present to some extent in the normal neonate because of immature development of these systems.

Signs and symptoms of Staphylococcal Scalded Skin Syndrome

SSSS usually starts with fever, irritability and widespread redness of the skin. Within 24-48 hours fluid-filled blisters form. These rupture easily, leaving an area that looks like a burn.

SSSS can often be traced to a prodromal upper respiratory tract infection, possibly with concomitant purulent conjunctivitis. Cutaneous changes progress through three stages.

Erythema :- In the first stage, erythema becomes visible, usually around the mouth and other orifices, as well as body fold areas, and may spread in widening circles over the entire body surface. The skin becomes tender; Nikolsky's sign (sloughing of the skin when friction is applied) may appear.

Exfoliation :- About 24 to 48 hours later, exfoliation occurs. In the more common, localized form of this disease, superficial erosions and minimal crusting develop, generally around body orifices, and may spread to exposed areas of the skin.

In the more severe forms of this disease, large, flaccid bullae erupt and may spread to cover extensive areas of the body. These bullae eventually rupture, revealing denuded skin.

Desquamation :- In this final stage, affected areas dry up and powdery scales form. Normal skin replaces these scales in 5 to 7 days.

Diagnosis

Careful observation of the three-stage progression of this disease allows diagnosis. Results of exfoliative cytology and a biopsy aid in the differential diagnosis, ruling out erythema multiforme and drug-induced toxic epidermal necrolysis, both of which are similar to SSSS.

Treatment of Staphylococcal Scalded Skin Syndrome

Systemic antibiotics, usually penicillinase-resistant penicillin, treat the underlying infection. Replacement measures maintain fluid and electrolyte balance.

A variety of lotions and creams are available to apply to areas where the epidermis has peeled away. This both soothes the sensitive areas, and protects against drying and further moisture loss. The prompt use of antibiotics is the medical treatment of choice. It is very important to take supplemental friendly bacteria both during and after antibiotic treatment in order to keep the friendly bacteria in strong numbers.

Prevention

As always, good hygiene can prevent the passage of the causative bacteria between people. In the event of an outbreak in a newborn nursery, members of the staff should have nasal smears taken to identify an adult who may be unknowingly carrying the bacteria and passing it on to the babies.