Staphylococcal Scalded Skin Syndrome (SSSS) Clinical Presentation

Updated: May 13, 2019
  • Author: Randall W King, MD, FACEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
  • Print
Presentation

History

Staphylococcal scalded skin syndrome (SSSS) presents as a macular erythema 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

Next:

Physical

The following may be noted:

  • Fever, although patients may be afebrile

  • Tenderness to palpation

  • Warmth to palpation

  • Facial edema

  • Conjunctivitis

  • Perioral crusting, but mucous membranes are spared

  • 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) [21, 22]

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

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

Staphylococcal scalded skin syndrome. Photograph b Staphylococcal 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 b Staphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP.
Staphylococcal scalded skin syndrome. Photograph b Staphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP.
Staphylococcal scalded skin syndrome. Photograph b Staphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP.
Previous
Next:

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. [19]

Reports implicating MRSA and community-acquired methicillin Staphylococcus aureus (CA-MRSA) as a cause of staphylococcal scalded skin syndrome are increasing. [23, 24, 25]

Previous