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Patient Information Leaflet

Staphylococcal Scalded Skin Syndrome 

What are the aims of this leaflet?

This leaflet has been written to help you understand more about the staphylococcal scalded skin syndrome (SSSS). It tells you what it is, what causes it, what can be done about it, and where you can find out more about it.

What is the staphylococcal scalded skin syndrome?

Staphylococcal scalded skin syndrome is a widespread painful rash caused by a bacterium (germ), known as Staphylococcus aureus. This germ produces a toxin that causes the outer layer of the skin to be shed.  

What causes the staphylococcal scalded skin syndrome?

Staphyloccoccus aureus is the commonest bacterium to infect the skin, eyes and nose. For example, it is the usual cause of impetigo, boils, abscesses, styes and conjunctivitis, and of infections in grazes, wounds, and in pre-existing skin conditions such as eczema.

Different types of this germ produce a variety of toxins (chemicals), causing other diseases. One of these is the exfoliative (also called epidermolytic) toxin which damages the proteins that bind skin cells together, resulting in splitting of a thin outer layer of skin.

If a toxin-producing type of Staphylococcus aureus infects the skin, it can cause thin-roofed, easily–torn blisters to appear at the site of infection. This condition is known as the bullous (blistering) type of impetigo.

The toxin is eliminated by the immune system and the kidneys. If either of these is not working properly, the toxin can circulate in the blood and affect most of the body surface. The appearance then looks like a scald, and for this reason widespread involvement of this type has become known as the staphylococcal scalded skin syndrome.

In young children, especially the newborn, the immune system and the kidneys are not fully developed, and this explains why they are most commonly affected. SSSS is rare in adults, but can affect those with kidney failure or immune deficiency.

The staphylococcus germ can be passed from person to person. Sometimes it can be passed on by someone who carries the germ but who has no actual infection.

(Note: toxic epidermal necrolysis (TEN) is a similar-looking condition which is rare in children, and nearly always caused by a drug reaction. SSSS was originally regarded as one form of TEN, but is now known to be a quite separate disease.) 

Is it hereditary?

No.

What are the features of the staphylococcal scalded skin syndrome?

The original infection may be relatively minor, for example an infected graze or a red sticky eye. A few days after it begins, a widespread patchy red rash appears and rapidly joins up to cover most of the skin surface. Unlike most rashes it is painful, and affected children are miserable and feverish. Soon there is loosening of a thin outer layer of skin, sometimes with easily torn fluid-filled blisters, but sometimes with areas of skin just sliding off the underlying layers.

If large areas of skin are shed, body fluid and salts can be lost, and further infection may get through into the bloodstream. Both of these events can be very serious.

How will it be diagnosed?

The diagnosis may be clear from the appearance of the skin. Surface fluid or pus may be sampled to confirm the presence of the bacteria, and in some cases blood will also be tested for infection. A small piece of skin may be sent for microscopic examination.

Can it be cured?

In most cases SSSS is cured completely, especially if treatment starts early.

How can it be treated?

The infection is treated with antibiotics, which in severe cases may be given through a vein. The skin needs gentle cleansing and a soothing ointment or dressings, which may include antibiotics or antiseptics. Special medical care is needed if fluid or salt balance is affected, or if there is a blood infection.  Hygienic measures are necessary to prevent the spread of infection to others.

Where can I find out more about the staphylococcal scalded skin syndrome?

Web links to detailed leaflets:
www.emedicine.com/DERM/topic402.htm
http://dermnetnz.org/bacterial/scalded-skin-syndrome.html
http://www.nlm.nih.gov/medlineplus/ency/article/001352.htm

The British Skin Foundation fund vital research into all skin diseases.  To find out how you can help, please visit the British Skin Foundation website here.

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: its contents, however, may occasionally differ from the advice given to you by your doctor.

BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED DECEMBER 2006
UPDATED DECEMBER 2009