Staphylococcal scalded skin syndrome

Staphylococcal scalded skin syndrome: Excerpt from Handbook of Diseases

A severe skin disorder, staphylococcal scalded skin syndrome (SSSS) is marked by epidermal erythema, peeling, and superficial necrosis that give the skin a scalded appearance. SSSS is most prevalent in infants ages 1 to 3 months but may develop in children; it’s rare in adults.

This disease follows a consistent pattern of progression, and most patients recover fully. Mortality is 2% to 3%, with death usually resulting from complications of fluid and electrolyte loss, sepsis, and involvement of other body systems.

Causes

The causative organism in SSSS is Group 2 Staphylococcus aureus, primarily phage type 71. Predisposing factors may include impaired immunity and renal insufficiency — present to some extent in the normal neonate because of immature development of these systems.

Signs and symptoms

SSSS commonly can be traced to a prodromal upper respiratory tract infection, possibly with concomitant purulent conjunctivitis. Cutaneous changes progress through three stages.

Erythema

In the first stage, erythema becomes visible, usually around the mouth and other orifices, as well as body fold areas, and may spread in widening circles over the entire body surface. The skin becomes tender; Nikolsky’s sign (sloughing of the skin when friction is applied) may appear.

Exfoliation

About 24 to 48 hours later, exfoliation occurs. In the more common, localized form of this disease, superficial erosions and minimal crusting develop, generally around body orifices, and may spread to exposed areas of the skin.

In the more severe forms of this disease, large, flaccid bullae erupt and may spread to cover extensive areas of the body. These bullae eventually rupture, revealing denuded skin.

Desquamation

In this final stage, affected areas dry up and powdery scales form. Normal skin replaces these scales in 5 to 7 days.

Diagnosis

Careful observation of the three-stage progression of this disease allows diagnosis. Results of exfoliative cytology and a biopsy aid in the differential diagnosis, ruling out erythema multiforme and drug-induced toxic epidermal necrolysis, both of which are similar to SSSS.

CLINICAL TIP: A blood culture is necessary to rule out sepsis.

Treatment

Systemic antibiotics treat the underlying infection. Replacement measures maintain fluid and electrolyte balance to prevent dehydration. Moist compresses may improve comfort, and an emollient may help keep skin moist.

Special considerations

❑ Provide special care for the neonate, if required, including placement in a warming infant incubator to maintain body temperature and provide isolation.

❑ Carefully monitor intake and output to assess fluid and electrolyte balance. In severe cases, I.V. fluid replacement may be necessary.

❑ Check vital signs. Be especially alert for a sudden rise in temperature, indicating sepsis, which requires prompt, aggressive treatment.

❑ Maintain skin integrity. Remember to use strict aseptic technique to preclude secondary infection, especially during the exfoliative stage, because of open lesions.

❑ To prevent friction and sloughing of the patient’s skin, leave affected areas uncovered or loosely covered. Place cotton between fingers and toes that are severely affected to prevent webbing.

❑ Administer warm baths and soaks during the recovery period. Gently debride exfoliated areas.

❑ Reassure parents that complications are rare and that residual scars are unlikely.

Book Source Details

• Book Title: Handbook of Diseases
• Author(s): Springhouse
• Year of Publication: 2003
• Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.

More About Warts

• Back to disease: Warts: Introduction
• Next Book Extract About Warts: Skin, clammy (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• More Book Extracts: All Online Books for Warts

More Medical Textbooks Online about Warts

Review other book chapters online related to Warts:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5

 » Next page: Skin, clammy (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Skin, clammy (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• Skin, mottled (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• Pustular rash (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• Skin, bronze (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• Skin, clammy (Signs & Symptoms: A 2-in-1 Reference for Nurses)

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City