Staphylococcal scalded skin syndrome (SSSS)

Published on 11/06/2015 by admin

Filed under Pediatrics

Last modified 22/04/2025

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Newborn with SSSS. Red, tender skin with perioral and periorbital crusting.

Newborn with SSSS with widespread red, shiny erosions surrounded by thin, peeling epidermis.

Infant with SSSS. Red, painful skin and red, shiny erosions with thin epidermal peeling.

Child with SSSS. Painful red cheeks with initial perioral crusting.

CLINICAL FEATURES

The abrupt onset of red, exceedingly painful skin that separates with the slightest friction leaving red, shiny erosions with a border of thin peeling epidermis characterizes SSSS.

Newborns will have the entire cutaneous surface involved with inability to maintain temperature control and will lose fluids and electrolytes. Mortality may be high as newborns do not readily make antitoxin. It may be introduced into the nursery by a staph carrier.

In infants and toddlers the involvement may be more localized to the upper body, and development of painful perioral, periorbittal and neck crusting is characteristic. Intact blisters are seldom seen. SSSS often occurs following a mild upper respiratory infection. The nares often harbor the responsible staphylococci. It is rarely seen over age 5 years. Infants and toddlers readily make neutralizing antitoxin, limiting the reaction to 1 to 3 days.

SSSS is the result of a bacterial toxin staph exfoliatin A, a serine protease that binds to desmoglein I and is produced by only certain strains of staphylococci [Phage group II]. A tiny amount of staph produces enough toxin to exfoliate a human.

The toxin circulates to the skin from the infectious site and specifically injures the granular layer of the epidermis, producing a separation of the outer one-third of the epidermis after the slightest friction to the skin.

TREATMENT

Newborns must have prompt administration of intravenous dicloxacillin or other antistaph drugs and restoration of fluid and electrolytes. Temperature control is necessary. Minimal handling of the baby is imperative as friction to the skin induces more separation and pain. Screening cultures of nursery personnel and visitors and institution of sterile techniques is critical as nursery epidemics with high mortality rate have been described.

Infants and toddlers require minimal handling the first 24 hours. Treatment with oral antibiotics such as dicloxacillin 15 to 50 mg/kg/day for 7 to 10 days is recommended. After the pain diminishes, a lubricating ointment may be applied twice daily to speed healing of desquamated sites.