Staphylococcal Scalded Skin Syndrome (SSSS) Workup

Updated: Nov 03, 2022
  • Author: Randall W King, MD, FACEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
  • Print

Laboratory Studies

White blood count (WBC) may be elevated; however, often WBC is normal.

Erythrocyte sedimentation rate (ESR) frequently is elevated.

Electrolytes and renal function should be followed closely in severe cases where fluid losses and dehydration via denuded skin are a concern.

A polymerase chain reaction (PCR) serum test for the toxin is available.

Typing of staphylococcal isolates for phage and subtype and the presence of exotoxin production is usually not necessary but is available at some centers

Cultures of bullae are negative in the absence of contamination.

Blood culture is usually negative in children (but positive in bullous impetigo) and is usually positive in adults

A Gram stain and/or culture from the remote infection site may confirm staphylococcal infection.


Imaging Studies

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



A biopsy of the affected area will demonstrate separation of the epidermis at the granular layer. An inflammatory cell infiltrate is typically not present. Immunofluorescence and the presence of antibodies that are common in pemphigus foliaceous are not present in staphylococcal scalded skin syndrome (SSSS). In toxic epidermal necrolysis (TEN), an inflammatory (lymphocytic) infiltrate is present, and the plane of separation is deeper, at the level of the basement membrane.

Frozen section of the peeled skin confirms the site of cleavage as superficial. Toxic epidermal necrolysis (TEN) shows deeper cleavage below the epidermis.