Staphylococcal Scalded Skin Syndrome (SSSS) Treatment & Management

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

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. 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. [26, 27]

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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