Staphylococcal scalded skin syndrome in Children

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.

Causes
The causative organism in SSSS is Group 2 Staphylococcus aureus, primarily phage type 71. 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
SSSS commonly can 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
Systemic antibiotics treat the underlying infection. Replacement measures maintain fluid and electrolyte balance to prevent dehydration. Moist compresses may improve comfort, and an emollient may help keep skin moist.