6th July 2023

Staphylococcal Scalded Skin Syndrome (SSSS)

An acute blistering skin condition caused by staphylococcal toxin. Group II coagulase-positive staphylococci toxins damage desmoglein 1 and subsequently cause the upper epidermis to split and shed. Primarily seen in children under 5 years old, however, SSSS has been noted in immunodeficient and renal failure patients. 40% of adults are asymptomatic nasal carriers of S. aureus.

Areas typically affected include the groin, face, axilla and neck. SSSS develops within hours to days with widespread tender erythematous skin followed by large flaccid bullae. These rupture easily under gentle pressure (Nikolsky’s sign) leaving large denuded areas that resemble a scald. The patient is also systemically unwell.

SSSS in a neonate

Image Source: Wikimedia Commons (2016). OSC Microbio 21 02 SSSS, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:OSC_Microbio_21_02_SSSS.jpg (Accessed on: 10 March 2022).

Diagnosis is usually clinical. Swabs are taken from an area of possible primary infection (e.g. nasopharynx, surgical wound) and blood cultures obtained. Nasal swabs are performed on close contacts to identify asymptomatic carriers. Skin biopsy demonstrates intraepidermal cleavage at the granular layer. Supportive management is with emollients (e.g. 50% liquid paraffin & 50% white soft paraffin), fluid balance management and analgesia. A penicillinase-resistant, anti-staphylococcal antibiotic (e.g. flucloxacillin) is used to eradicate the infection. Recovery with skin healing is within 5 days.