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.

Procedures

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.

Treatment & Management

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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.