eMedicine Specialties > Emergency Medicine > Infectious Diseases

Staphylococcal Scalded Skin Syndrome: Follow-up

Author: Randall W King, MD, Assistant Clinical Professor of Emergency Medicine, The University of Toledo College of Medicine; Program Director Emergency Medicine Residency, Associate Chair, Department of Emergency Medicine, St Vincent Mercy Medical Center
Coauthor(s): Paul R de Saint Victor, MD, FACEP, Chief of Staff, St Vincent Mercy Medical Center, Toledo
Contributor Information and Disclosures

Updated: Jun 18, 2009

Follow-up

Further Inpatient Care

  • Further inpatient care for patients with staphylococcal scalded skin syndrome (SSSS) involves fluid rehydration, local burn/wound care, and eradication of the underlying infection.

Transfer

  • Patients with severe disease may require ICU or burn unit care.

Deterrence/Prevention

  • Avoidance of the primary staphylococcal infection that may lead to the toxic syndrome
  • Timely treatment of established staphylococcal infections
  • Identification and treatment of asymptomatic carriers

Complications

Complications of staphylococcal scalded skin syndrome may include the following:

  • Dehydration
  • Shock
  • Hypothermia
  • Generalized bacteremia and/or sepsis
  • Local or remote spread of infection
  • Secondary infections
  • Scarring, disability, and death

Prognosis

  • Prognosis of staphylococcal scalded skin syndrome (SSSS) in children is excellent, with complete healing typically occurring in 10 days without significant scarring.
  • Prognosis of staphylococcal scalded skin syndrome in adults depends on the host's immune status, the speed in initiating proper treatment, the course of the infection, and the occurrence of complications. Staphylococcal scalded skin syndrome in adults carries significant rates of morbidity and mortality.

Miscellaneous

Medicolegal Pitfalls

  • Differentiating between staphylococcal scalded skin syndrome (SSSS) and more dangerous dermatologic conditions, such as toxic epidermal necrolysis (TEN) and pemphigus in the early stages of disease, can be difficult. Care should be taken to establish the correct diagnosis and as well to have a low threshold for specialty consultation as well as ICU and/or burn unit care. 
  • In outbreaks of staphylococcal infections and staphylococcal scalded skin syndrome (SSSS), identifying and treating asymptomatic carriers is imperative. Universal precautions should be used at all times.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the medical review of this article by Joseph U Becker, MD.



More on Staphylococcal Scalded Skin Syndrome

Overview: Staphylococcal Scalded Skin Syndrome
Differential Diagnoses & Workup: Staphylococcal Scalded Skin Syndrome
Treatment & Medication: Staphylococcal Scalded Skin Syndrome
Follow-up: Staphylococcal Scalded Skin Syndrome
Multimedia: Staphylococcal Scalded Skin Syndrome
References
[ CLOSE WINDOW ]

References

  1. Adhisivam B, Mahadevan S. Abscess of the nasal septum with staphylococcal scalded skin syndrome. Indian Pediatr. Apr 2006;43(4):372-3. [Medline].

  2. Amagai M, Yamaguchi T, Hanakawa Y, Nishifuji K, Sugai M, Stanley JR. Staphylococcal exfoliative toxin B specifically cleaves desmoglein 1. J Invest Dermatol. May 2002;118(5):845-50. [Medline].

  3. Hanakawa Y, Stanley JR. Mechanisms of blister formation by staphylococcal toxins. J Biochem. Dec 2004;136(6):747-50. [Medline].

  4. Ladhani S. Understanding the mechanism of action of the exfoliative toxins of Staphylococcus aureus. FEMS Immunol Med Microbiol. Nov 28 2003;39(2):181-9. [Medline].

  5. Patel GK, Finlay AY. Staphylococcal scalded skin syndrome: diagnosis and management. Am J Clin Dermatol. 2003;4(3):165-75. [Medline].

  6. Murono K, Fujita K, Yoshioka H. Microbiologic characteristics of exfoliative toxin-producing Staphylococcus aureus. Pediatr Infect Dis J. May 1988;7(5):313-5. [Medline].

  7. Decleire PY, Blondiaux G, Delaere B, Glupczynski Y. Staphyloccocal scalded skin syndrome in an adult. Acta Clin Belg. Nov-Dec 2004;59(6):365-8. [Medline].

  8. Oono T, Kanzaki H, Yoshioka T, Arata J. Staphylococcal scalded skin syndrome in an adult. Identification of exfoliative toxin A and B genes by polymerase chain reaction. Dermatology. 1997;195(3):268-70. [Medline].

  9. Shirin S, Gottlieb AB, Stahl EB. Staphylococcal scalded skin syndrome in an immunocompetent adult: possible implication of low-dosage prednisone. Cutis. Nov 1998;62(5):223-4. [Medline].

  10. Wong GW, Oppenheimer SJ, Evans RM, Leung SS, Cheng JC. Pyomyositis and staphylococcal scalded skin syndrome. Acta Paediatr. Jan 1993;82(1):113-5. [Medline].

  11. Moss C, Gupta E. The Nikolsky sign in staphylococcal scalded skin syndrome. Arch Dis Child. Sep 1998;79(3):290. [Medline].

  12. Uzun S, Durdu M. The specificity and sensitivity of Nikolskiy sign in the diagnosis of pemphigus. J Am Acad Dermatol. Mar 2006;54(3):411-5. [Medline].

  13. Acland KM, Darvay A, Griffin C, Aali SA, Russell-Jones R. Staphylococcal scalded skin syndrome in an adult associated with methicillin-resistant Staphylococcus aureus. Br J Dermatol. Mar 1999;140(3):518-20. [Medline].

  14. Ito Y, Funabashi Yoh M, Toda K, Shimazaki M, Nakamura T, Morita E. Staphylococcal scalded-skin syndrome in an adult due to methicillin-resistant Staphylococcus aureus. J Infect Chemother. Sep 2002;8(3):256-61. [Medline].

  15. Noguchi N, Nakaminami H, Nishijima S, Kurokawa I, So H, Sasatsu M. Antimicrobial agent of susceptibilities and antiseptic resistance gene distribution among methicillin-resistant Staphylococcus aureus isolates from patients with impetigo and staphylococcal scalded skin syndrome. J Clin Microbiol. Jun 2006;44(6):2119-25. [Medline].

  16. Baartmans MG, Maas MH, Dokter J. Neonate with staphylococcal scalded skin syndrome. Arch Dis Child Fetal Neonatal Ed. Jan 2006;91(1):F25. [Medline].

  17. Chi CY, Wang SM, Lin HC, Liu CC. A clinical and microbiological comparison of Staphylococcus aureus toxic shock and scalded skin syndromes in children. Clin Infect Dis. Jan 15 2006;42(2):181-5. [Medline].

  18. Cribier B, Piemont Y, Grosshans E. Staphylococcal scalded skin syndrome in adults. A clinical review illustrated with a new case. J Am Acad Dermatol. Feb 1994;30(2 Pt 2):319-24. [Medline].

  19. El Helali N, Carbonne A, Naas T, et al. Nosocomial outbreak of staphylococcal scalded skin syndrome in neonates: epidemiological investigation and control. J Hosp Infect. Oct 2005;61(2):130-8. [Medline].

  20. Ginsburg CM. Staphylococcal toxin syndromes. Pediatr Infect Dis J. Apr 1991;10(4):319-21. [Medline].

  21. Greenwood JE, Dunn KW, Davenport PJ. Experience with severe extensive blistering skin disease in a paediatric burns unit. Burns. Feb 2000;26(1):82-7. [Medline].

  22. Hedrick J. Acute bacterial skin infections in pediatric medicine: current issues in presentation and treatment. Paediatr Drugs. 2003;5 Suppl 1:35-46. [Medline].

  23. Hochman MA, Mayers M. Stevens-Johnson syndrome, epidermolysis bullosa, staphylococcal scalded skin syndrome, and dermatitis herpetiformis. Int Ophthalmol Clin. Spring 1997;37(2):77-92. [Medline].

  24. Johnston GA. Treatment of bullous impetigo and the staphylococcal scalded skin syndrome in infants. Expert Rev Anti Infect Ther. Jun 2004;2(3):439-46. [Medline].

  25. Ladhani S, Evans RW. Staphylococcal scalded skin syndrome. Arch Dis Child. Jan 1998;78(1):85-8. [Medline].

  26. Ladhani S, Joannou CL, Lochrie DP, Evans RW, Poston SM. Clinical, microbial, and biochemical aspects of the exfoliative toxins causing staphylococcal scalded-skin syndrome. Clin Microbiol Rev. Apr 1999;12(2):224-42. [Medline].

  27. Lina G, Gillet Y, Vandenesch F, Jones ME, Floret D, Etienne J. Toxin involvement in staphylococcal scalded skin syndrome. Clin Infect Dis. Dec 1997;25(6):1369-73. [Medline].

  28. Payne AS, Hanakawa Y, Amagai M, Stanley JR. Desmosomes and disease: pemphigus and bullous impetigo. Curr Opin Cell Biol. Oct 2004;16(5):536-43. [Medline].

  29. Prevost G, Couppie P, Monteil H. Staphylococcal epidermolysins. Curr Opin Infect Dis. Apr 2003;16(2):71-6. [Medline].

  30. Resnick SD. Staphylococcal toxin-mediated syndromes in childhood. Semin Dermatol. Mar 1992;11(1):11-8. [Medline].

  31. Rodriguez Prieto MA, Manchado Lopez P, Ruiz Gonzalez I. Toxic epidermal necrolysis associated with scalded skin syndrome in an adult. Int J Dermatol. Nov 1997;36(11):875-6. [Medline].

  32. Shelley ED, Shelley WB, Talanin NY. Chronic staphylococcal scalded skin syndrome. Br J Dermatol. Aug 1998;139(2):319-24. [Medline].

  33. Veien NK. The clinician's choice of antibiotics in the treatment of bacterial skin infection. Br J Dermatol. Dec 1998;139 Suppl 53:30-6. [Medline].

  34. Whittock NV, Bower C. Targetting of desmoglein 1 in inherited and acquired skin diseases. Clin Exp Dermatol. Jul 2003;28(4):410-5. [Medline].

  35. Williams RE, MacKie RM. The staphylococci. Importance of their control in the management of skin disease. Dermatol Clin. Jan 1993;11(1):201-6. [Medline].

  36. Wooldridge WE. Managing skin infections in children. Postgrad Med. Mar 1991;89(4):109-12. [Medline].

  37. Yamasaki O, Yamaguchi T, Sugai M, et al. Clinical manifestations of staphylococcal scalded-skin syndrome depend on serotypes of exfoliative toxins. J Clin Microbiol. Apr 2005;43(4):1890-3. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

staphylococcal scalded skin syndrome, SSSS, blistering skin, Ritter von Ritterschein disease, Ritter disease, Ritter’s disease, Lyell disease, Lyell’s disease, skin disease, skin condition, treatment, symptoms, causes, exfoliative toxins, toxin-mediated syndrome, staphylococcal epidermal necrolysis, acute exfoliation of the skin, staphylococcal infection, erythematous cellulitis, phage group 2 Staphylococcus aureus, S aureus, epidermolytic toxins

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

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

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.

Medical Editor

Daniel J Dire, MD, FACEP, FAAP, FAAEM, Clinical Associate Professor, Department of Emergency Medicine, University of Texas-Houston
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: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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

CME Editor

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, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.