Staphylococcal Scalded Skin Syndrome in Emergency Medicine Treatment & Management

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

Prehospital Care

In the prehospital phase, treatment will be likely limited to antipyretic therapy and treatment of the dehydration with intravenous fluid therapy during transport. Most patients are brought to the emergency department by parents or caregivers.

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Emergency Department Care

The major focus of ED care should be to identify staphylococcal scalded skin syndrome (SSSS) and to stabilize the patient's condition.

Once SSSS is diagnosed, the treatment consists of supportive care and eradication of the primary infection.

Patients need fluid rehydration, topical wound care similar to the care for thermal burns, and parenteral antibiotics to cover S aureus.

Consideration must be given for the sharply increasing rates of community-acquired S aureus infection (CA-MRSA). Prompt treatment with parenteral anti-staphylococcal antibiotics is essential. Most staphylococcal infections implicated in staphylococcal scalded skin syndrome have penicillinases and are resistant to penicillin. Nafcillin, oxacillin, or vancomycin is indicated.

Clindamycin may also be used to inhibit bacterial ribosomal production of exotoxin.

Fluid rehydration is initiated with Lactated Ringer solution at 20 mL/kg initial bolus. Repeat the initial bolus, as clinically indicated, followed by maintenance therapy with consideration for fluid losses from exfoliation of skin being similar to a burn patient.

Topical wound care, in severe cases, in a dedicated burn center should be provided.

Cultures from the exfoliated sites as well as nose, throat, and other potential sites of the original focus of infection should be performed.

A chest radiograph should be considered to rule out pneumonia as the original focus of infection.

Steroids are not indicated and may worsen immune function.

Nonsteroidal anti-inflammatory agents and other agents that potentially reduce renal function should be avoided

Differentiating staphylococcal scalded skin syndrome (SSSS) from toxic epidermal necrolysis (TEN), which carries a much higher mortality, is important. In SSSS, the mucous membranes are spared. In TEN, the mucous membranes are almost always affected (mouth, conjunctiva, trachea, esophagus, anus, vagina).

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Consultations

Consultation with the following may be indicated:

  • Pediatrician
  • Dermatologist
  • Possibly, infectious disease and burn specialists (eg, plastic surgeon)
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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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