Staphylococcal Scalded Skin Syndrome in Emergency Medicine Clinical Presentation

  • Author: Randall W King, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 4, 2010
 

History

Staphylococcal scalded skin syndrome (SSSS) presents as a red rash followed by diffuse epidermal exfoliation.

A prodromal localized S aureus infection of the skin, throat, nose, mouth, umbilicus, or GI tract occurs. Such an infection often is not apparent before the SSSS rash appears.

The following may be noted:

  • General malaise
  • Fever
  • Irritability
  • Skin tenderness
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Physical

The following may be noted:

  • Fever, although patients may be afebrile
  • Tenderness to palpation
  • Warmth to palpation
  • Facial edema
  • Perioral crusting
  • Most patients do not appear severely ill.
  • Dehydration may be present and significant.
  • Nikolsky sign (gentle stroking of the skin causes the skin to separate at the epidermis)[20, 21]

Diffuse erythematous rash often begins centrally, is sandpaperlike (progressing into a wrinkled appearance, and accentuated in flexor creases. See the images below.

Staphylococcal scalded skin syndrome. Photograph bStaphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP. Staphylococcal scalded skin syndrome. Photograph bStaphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP.

Bullae are flaccid and ill defined. See the image below.

Staphylococcal scalded skin syndrome. Photograph bStaphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP.

Exfoliation of skin, which may be patchy or sheetlike in nature, is noted. See the images below.

Staphylococcal scalded skin syndrome. Photograph bStaphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP. Staphylococcal scalded skin syndrome. Photograph bStaphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP. Staphylococcal scalded skin syndrome. Photograph bStaphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP.
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Causes

Infection by group 2 phage S aureus (several types) leads to release of exotoxin.

Exotoxin is a protein and is classified as either type A or B. Most are type A.

Exotoxin causes separation of the epidermis beneath the granular cell layer.

Cases of staphylococcal scalded skin syndrome (SSSS) have been reported among infants who have breastfed from mothers with S aureus breast abscess.

A case has been reported of neonatal staphylococcal scalded skin syndrome secondary to maternal-fetal transmission at birth.

Outbreaks have been reported in neonatal and newborn nurseries.[18]

Reports implicating MRSA and community-acquired methicillin Staphylococcus aureus (CA-MRSA) as a cause of staphylococcal scalded skin syndrome are increasing.[22, 23, 24]

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Contributor Information and Disclosures
Author

Randall W King, MD, FACEP  Assistant Clinical Professor of Emergency Medicine, The University of Toledo College of Medicine; Director, Emergency Medicine Residency Program, Associate Chair, Department of Emergency Medicine, St Vincent Mercy Medical Center

Randall W King, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, Ohio State Medical Association, and Society for Academic Emergency Medicine

Disclosure: Challenger corporation None Physician Advisory Board; Ohio ACEP Consulting fee Editor Rivers review text Emergency Medicine

Coauthor(s)

Paul R de Saint Victor, MD, FACEP  Chief of Staff, St Vincent Mercy Medical Center, Toledo

Paul R de Saint Victor, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Heart Association, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Dire, MD, FACEP, FAAP, FAAEM  Clinical Professor, Department of Emergency Medicine, University of Texas-Houston; Clinical Professor, Department of Pediatrics, University of Texas Health Sciences Center, San Antonio, Texas

Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US

Disclosure: Talecris Biotherapeutics Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jeter (Jay) Pritchard Taylor III, MD  Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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Staphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP.
Staphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP.
Staphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP.
Staphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP.
Staphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP.
Staphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP.
 
 
 
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