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Home :: Staphylococcal Scalded-Skin Syndrome

Staphylococcal Scalded-Skin Syndrome

Staphylococcal scalded-skin syndrome (SSSS) is a toxin-mediated epidermolytic disease characterized by erythema, widespread detachment of the superficial layers of the epidermis, resembling scalding, and occurring mainly in newborns and infants younger than 2 years. Severity ranges from a localized form, bullous impetigo, to a generalized form with extensive epidermolysis and desquamation. The clinical spectrum of SSSS includes

  1. bullous impetigo
  2. bullous impetigo with generalization
  3. scarlatiniform syndrome
  4. generalized scalded-skin syndrome.

Causes of Staphylococcal Scalded-Skin Syndrome

In newborns and infants, S.aureus colonizes nose, conjunctivae, or umbilical stump with or without causing clinically apparent infection, producing an exotoxin that is transported hematogenously to the skin. In bullous impetigo exotoxin is produced in impetigo lesion. Specific antistaphylococcal antibody, metabolic differences, or greater ability to localize, metabolize, and excrete in individuals older than 10 years probably accounts for decreased incidence of SSSS with older age. At times purulent conjunctivitis, otitis media, or occult nasopharyngeal infection occurs at site of toxin production. The exfoliative toxin causes acantholysis and intraepidermal cleavage within the stratum granulosum. The few cases of SSSS reported in adults were associated with immunodeficiency or renal insufficiency. Local effects of the toxin result in bullous impetigo, but with absorption of the toxin, a mild scarlatiniform rash accompanying the bullous lesions may appear. Conversely, local effects of the toxin may be absent, with systemic absorption resulting in a staphylococcal scarlet fever syndrome. More extensive epidermal damage is characterized by sloughing of superficial epidermis in SSSS. Healing spontaneously occurs in 5 to 7 days.

Symptoms of Staphylococcal Scalded-Skin Syndrome

  • crusted infection site, often around the nose or ears
  • red, painful areas around infection site
  • blistering
  • fever
  • chills
  • weakness
  • fluid loss
  • top layer of skin begins peeling off in sheets


Clinical findings confirmed by bacterial cultures.


General Care Hospitalization is recommended for neonates and young children, especially if skin sloughing is extensive and parental compliance questionable. Discharge home when significant improvement is apparent. If case is mild and home care reliable, children can be treated with oral antibiotic.

Topical Therapy Baths or compresses for debridement of necrotic superficial epidermis. Topical antimicrobial agents for impetigo lesions: mupirocin ointment, bacitracin, or silver sulfadiazine ointment. Avoid triple antibiotic ointment containing neomycin, which is a frequent allergen that causes contact dermatitis.

Systemic Antimicrobial Therapy

Adjunctive Therapy Replace significant water and electrolyte loss intravenously in severe cases.

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