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.

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. Penicillinase-resistant synthetic penicillins such as nafcillin or oxacillin should be started promptly. In areas with significant MRSA prevalence (or if MRSA is suspected), antibiotics with MRSA coverage (eg, vancomycin or linezolid) are indicated.^{[28, 29]}

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).

Consultations

Consultation with the following may be indicated:

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

Medication

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Media Gallery

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.

of 6

Author

Randall W King, MD, FACEP Assistant Clinical Professor of Emergency Medicine, University of Toledo College of Medicine; Director, Emergency Medicine Residency Program, Department of Emergency Medicine, Chief Medical Information Officer, Chief of Staff Elect, Mercy St Vincent Medical Center

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

Disclosure: Nothing to disclose.

Coauthor(s)

Heather Lyn Carone, MD Attending Physician, Department of Emergency Medicine, St Vincent Mercy Medical Center

Heather Lyn Carone, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician / Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Prisma Health Richland Hospital

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, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor - Chief Editor for Medscape.

Additional Contributors

Daniel J Dire, MD, FACEP, FAAP, FAAEM Professor of Pediatrics and Emergency Medicine, University of Texas Health Science Center at San Antonio, Joe R and Teresa Lozano Long School of Medicine

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, Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Acknowledgements

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