Staphylococcal scalded skin syndrome (SSSS) is a rare but serious bacterial skin infection caused by Staphylococcus aureus. It is most commonly seen in young children and infants, although cases have been reported in adults as well. SSSS is characterized by widespread blistering, peeling and flaking of the skin, giving it a “burned” appearance. SSSS is caused by specific strains of Staphylococcus aureus that produces exfoliative toxins which lead to the breakdown of the protein that holds the skin cells together, leading to the formation of blisters and the subsequent detachment of the skin.

Risk Factors

The following factors increase the risk of SSSS:

  • Age: Young children and infants are most commonly affected by SSSS.
  • Immunosuppressed patients have a higher risk
  • Patients with cuts, abrasions, or other skin damage, as well as those with chronic skin conditions like eczema are at increased risk of developing SSSS.
  • Patients with a history of staph infections

Symptoms

The symptoms of SSSS typically appear 2-3 days after the initial infection and may include:

  • Blisters: Red, painful blisters that burst easily and leave raw, exposed skin.
  • Peeling: The skin may start to peel and flake, giving it a “burned” appearance.
  • Rash: A red, scaly rash may develop over large areas of the body.
  • Fever: A low-grade fever is common in SSSS cases.
  • Mucosal involvement: In severe cases, the mouth, eyes, and genital area may be affected.

Many patients with SSSS are ill appearing and irritable.

A child with SSSS – courtesy Brad Sobolewski, MD, MEd

Diagnosis

The diagnosis of SSSS is made based on the patient’s symptoms and a physical examination. A sample of fluid from a blister may be cultured to confirm the presence of Staphylococcus aureus.

Treatment

Treatment for SSSS typically involves antibiotics to clear the infection and supportive care to manage symptoms. Hospitalization is often necessary to provide intravenous antibiotics and fluid replacement. The antibiotic of choice for staphylococcal scalded skin syndrome (SSSS) is typically a penicillin – methicillin, nafcillin, or oxacillin. The Staph aureus that causes SSSS is not generally MRSA. In “true” penicillin allergy clindamycin or vancomycin may be used. Supportive care includes IV fluids, pain management and wound care. In severe cases, skin grafting may be necessary to repair damaged skin.

Prevention

You can recommend the following measures can help patients prevent the spread of staph infections:

  • Good hygiene: Wash your hands frequently and clean cuts and abrasions promptly.
  • Avoid sharing personal items: Avoid sharing towels, razors, or other personal items that may be contaminated with Staphylococcus aureus.
  • Cover wounds: Cover cuts and abrasions with a clean, dry bandage.
  • Seek prompt treatment: If you develop symptoms of a staph infection, seek prompt medical attention.

References

Braunstein I, Wanat KA, Abuabara K, McGowan KL, Yan AC, Treat JR. Antibiotic sensitivity and resistance patterns in pediatric staphylococcal scalded skin syndrome. Pediatr Dermatol. 2014 May-Jun;31(3):305-8.

Ross A, Shoff HW. Staphylococcal Scalded Skin Syndrome. [Updated 2022 Jul 26]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448135/