Staphylococcal Scalded Skin Syndrome

Sandi - posted on 04/12/2009

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Melissa, thanks for the great information and I am sorry you and Paige and your family had to experience all that.  But, it is nice to see Paige's smiling eyes in the profile picture.

I doubt what my son had was the same.  But, what my friends daughter had definately fits the description.  Have you found any/many families that have dealt with this? 

Staph can be anywhere...but I never thought of how it can affect the immune system of little ones.  Is it preventable?  Handwashing seems like it may have some benefit...but like with any virus even handwashing doesn't always work.  And is SSSS something fairly "new"?

Although I wonder if in immuno-compromised populations it is more common (poor nutrition, underdeveloped countries, AIDS, etc)? Tons of questions...which is mostly just me thinking out loud.  But, thanks for sharing your story and maybe others families will too?!  That is a cool thing about a post/thread.

Thanks again Melissa!

Melissa - posted on 04/12/2009

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Paige is the baby in the photo she is now 6 months old and you would never know that she suffered such a terrrible infection.

What is staphylococcal scalded skin syndrome?

Staphylococcal scalded skin syndrome (SSSS) is an
illness characterised by red blistering skin that looks like a burn or scald, hence its name staphylococcal scalded skin syndrome. SSSS is caused by the release of two exotoxins (epidermolytic toxins A and B) from toxigenic strains of the bacteria Staphylococcus aureus. Desmosomes are the part of the skin cell responsible for adhering to the adjacent skin cell. The toxins bind to a molecule within the desmosome called Desmoglein 1 and break it up so the skin cells become unstuck.

SSSS has also been called Ritter's disease or Lyell's disease when it appears in newborns or young infants.

Who is at risk of staphylococcal scalded skin syndrome?

SSSS occurs mostly in children younger than 5 years, particularly neonates (newborn babies). Lifelong protective antibodies against staphylococcal exotoxins are usually acquired during childhood which makes SSSS much less common in older children and adults. Lack of specific immunity to the toxins and an immature renal clearance system (toxins are primarily cleared from the body through the kidneys) make neonates the most at risk.

Immunocompromised individuals and individuals with renal failure, regardless of age, may also be at risk of SSSS.

What are the signs and symptoms of staphylococcal scalded skin syndrome?

SSSS usually starts with fever, irritability and widespread redness of the skin. Within 24-48 hours fluid-filled blisters form. These rupture easily, leaving an area that looks like a burn. Characteristics of the rash include:

•Tissue paper-like wrinkling of the skin is followed by the appearance of large fluid-filled blisters (bullae) in the armpits, groin and body orifices such as the nose and ears.
•Rash spreads to other parts of the body including the arms, legs and trunk. In newborns, lesions are often found in the diaper area or around the umbilical cord.
•Top layer of skin begins peeling off in sheets, leaving exposed a moist, red and tender area.
Other symptoms may include tender and painful areas around the infection site, weakness, and dehydration.

What is the treatment of staphylococcal scalded skin syndrome?

Treatment usually requires hospitalisation, as intravenous antibiotics are generally necessary to eradicate the staphylococcal infection. A penicillinase-resistant, anti-staphylococcal antibiotic such as flucloxacillin is used. Depending on response to treatment, oral antibiotics can be substituted within several days. The patient may be discharged from hospital to continue treatment at home.

Other supportive treatments include:

•Paracetamol when necessary for fever and pain.
•Maintaining fluid and electrolyte intake.
•Skin care (the skin is often very fragile)
Although the outward signs of SSSS look bad, children generally recover well and healing is usually complete within 5-7 days of starting treatment.


WE DID NOT KNOW THAT SHE HAD THIS UNTIL HER SKIN WAS PEELING OFF AND SHE NEEDED MORPHINE.

Melissa - posted on 04/12/2009

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Thanks :) yes it was very scary she was very very sick, they say that the rash does appear in the groin, Paige's did after having a urine bag removed all the skin peeled with it, also they had to give her morphine for the pain and two diffrent types of antiboitics she was placed in a humidy crib for 2 weeks she was fed through a nasal gastric tube and her body core temp had to be regulated, her skin healed perfectly she has no scars or any markings that would suggest she suffered from this, we where very lucky that she recovered as she was a very sick little girl.

Sandi - posted on 04/10/2009

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My friends 1 year old daughter had a visit to the Pediatrician (who sent he to Urgent Care) with this same infection.  But, she said they told her it was a virus.  I checked the Mayo Clinic and CDC websites.  The Mayo clinic lists it under Staph infections but does not give much detail.  And the CDC has nothing.  My son had a severe "diaper rash" for 3 weeks that did not clear up with anything (not even topical steriods)....I wonder?  He was afebrile and my friends daughter had a "diaper rash" with fever and the peeling skin you mention.  I hope you find more info. on this and I am curious to no end and hope to find more info too.  

I hope your daughter has recovered and is home with you now.  That would be scary!  And would you be willing to share how the healing of the skin has progressed and how long it took?  I hope you have/had a lot of support during this time...we send healing thoughts your way.

Melissa - posted on 04/10/2009

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she was addmitted to Intensive care as her whole body peeled she looked like a burns baby, she first off began vomiting and had diareah was very very wingy and her skin was dark red she then began to peel.