Staphylococcal scalded skin syndrome (SSSS) is caused by toxigenic strains of Staphylococcus aureus, a gram-positive, catalase-positive bacterium. The infection causes peeling skin over large parts of the body. This condition is characterized by blistering in the skin surface which more or less looks like a burn and that is what gives it the name of Staphylococcal Scalded Skin Syndrome. To guide PCH ED staff with the assessment and management of staphylococcal scalded skin syndrome in children. He or she may be in the burn unit of the hospital. However, it does predispose an individual to infection, espec… In young infants, and in those with renal impairment, these can accumulate and result in widespread exfoliation of the skin known as Staphylococcal scalded skin syndrome (SSSS). It is rare in adults, but when diagnosed, it often is associated with renal failure, immunodeficiency, or overwhelming staphylococcal infection. Tips to help you get the most from a visit to your child’s healthcare provider: At Another Johns Hopkins Member Hospital: CHG Bathing to Prevent HealthcareAssociated Infections, General Pediatrics and Adolescent Medicine, Long-term (chronic) kidney disease or kidney failure, Fluid-filled blisters that break easily and leave an area of moist skin that soon becomes tender and painful, Large sheets of the top layer of skin may peel away, Your child’s age, overall health, and medical history, How well your child handles certain medicines, treatments, or therapies, If your child’s condition is expected to get worse, The opinion of the healthcare providers involved in your child's care, Antibiotic medicine given by IV (intravenous) line into the vein, Feedings through a tube from the mouth into the stomach (nasogastric feeding), if needed, Use of skin creams or ointments and bandages, Loss of fluid causing dehydration and shock like a burn patient, Staphylococcal scalded skin syndrome is usually from a bacterial infection. The diagnosis of staphylococcal scalded skin syndrome (SSSS) can be made with confidence in the setting of a compatible clinical appearance with supporting histopathology, and established underlying Staphylococcal infection. | Open in Read by QxMD; Yamasaki O, Yamaguchi T, Sugai M. Clinical Manifestations of Staphylococcal Scalded-Skin Syndrome Depend on Serotypes of Exfoliative Toxins. It is a syndrome of acute exfoliation of the skin typically following an … Therefore, treatment with nafcillin, oxacillin, or vancomycin is typically indicated. This bacterium produces an … Epidemiology of staphylococcal scalded skin syndrome in Germany. The affected skin initially looks red, A unique case of a pregnant woman with chronic atopic dermatitis who developed SSSS is presented. Know what to expect if your child does not take the medicine or have the test or procedure. In children, the disease usually begins with fussiness (irritability), tiredness (malaise), and a fever. 0. Staphylococcal scalded skin syndrome (SSSS) is a serious skin infection caused by the bacterium Staphylococcus aureus. Description SSSS primarily strikes children under the age of five, particularly infants. Also know what the side effects are. This condition generally affects children < 5 years of age, and can be a severe and potentially life threatening illness, particularly in neonates Questions. Treatment includes antibiotic medicine, replacing fluids, and skin care. Toxic epidermal necrolysis produced by an extracellular product … Aim. Staphylococcal scalded skin syndrome (SSSS) is a dermatological condition caused by Staphylococcus aureus. The disease presents with the widespread formation of fluid-filled blisters that are thin walled and easily ruptured, and the patient can be positive for Nikolsky's sign. This is important if your child becomes ill and you have questions or need advice. It’s usually caused by an infection with a type of Staphylococcal aureas bacteria. Clindamycin is sometimes also used because of its inhibition of exotoxins. Perioral crusting and fissuring are seen early in the course. Staphylococcal scalded skin syndrome is a response to a toxin produced by a staphylococcal infection and is characterized by peeling skin. Staphylococcal scalded skin syndrome (SSSS) is a recognised clinical entity that affects primarily the very young and, in rare cases, the very old or the immunocompromised. This produces a toxin that damages the outer layer of the skin causing it blister and to peel. The toxins bind to a molecule within the desmosome called Desm… The specific toxigenic strains usually belong to phage group 2 (types 3A, 3B, 3C, 55, or 71). It is more common in infants than adults. It is caused by the release of exotoxins A and B from Staphylococcus aureus. SSSS is caused by the exfoliative toxins (epidermolytic toxins A and B) of some strains of Staphylococcus aureus. N/A. The prognosis in adults is generally much worse, and depends upon various factors such as time to treatment, host immunity, and comorbidities. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. However, SSSS must be differentiated carefully from toxic epidermal necrolysis, which carries a poor prognosis. Most of the time, these bacteria cause no problems or result in relatively minor skin infections. Staphylococcal scalded skin syndrome (SSSS) is an uncommon, superficial blistering skin condition, characterised by widespread erythema and exfoliation, mainly occuring in children under five years of age, although older children and adults can be affected. These exotoxins are proteases that cleave desmoglein-1, which normally holds the granulosum and spinosum layers together, similar to the pathophysiology of the autoimmune skin disease, pemphigus vulgaris. Only 5% of all S aureus strains produce the epidermolytic toxins responsible for SSSS. Staphylococcal Scalded Skin Syndrome Definition Staphylococcal scalded skin syndrome (SSSS) is a disease, caused by a type of bacteria, in which large sheets of skin may peel away. It rarely occurs in older people except for those with kidney failure or a weakened immune system. General Information | Self-Checker | Donate and Lend Support | Staff Appreciation | Get Email Alerts. 0. Staphylococcal scalded skin syndrome (SSSS), also known as Ritter von Ritterschein disease (in newborns), Ritter disease, and staphylococcal epidermal necrolysis, encompasses a spectrum of superficial blistering skin disorders caused by the exfoliative toxins of some strains of Staphylococcus aureus.. If your child has a follow-up appointment, write down the date, time, and purpose for that visit. Conservative measures include rehydration, antipyretics (e.g., ibuprofen or paracetamol), management of thermal burns, and stabilization. He or she will give your child a physical exam. doi: 10.1111/jdv.12541 . Staphylococcal scalded skin syndrome (SSSS) is a serious skin infection. It looks like the skin has been scalded or burned by hot liquid. Most strains of S. aureus implicated in SSSS have penicillinases, so are penicillin resistant. Staphylococcal scalded skin syndrome (SSSS) is a superficial blistering disorder mediated by Staphylococcus aureus exfoliative toxins. What you should be alert for in the history. Treatment usually requires a hospital stay, often in the burn or intensive care unit of the hospital. This is because the treatment is similar to treating a child with burns. It can occur at any age, but children under 5 years of age are at highest risk. Treatment usually involves antibiotics and drain… 0. The mainstay of treatment for SSSS is supportive care along with eradication of the primary infection. It looks like the skin has been scalded or burned by hot liquid. Know why a new medicine or treatment is prescribed and how it will help your child. Make sure your child sees his or her healthcare provider for a diagnosis. Review Topic. The staphylococcal scalded skin syndrome is an acute exfoliation of the skin caused by exfoliative toxins A and B. Staphylococcal scalded skin syndrome (SSSS) is a dermatological condition caused by Staphylococcus aureus. 1972 Feb; 125 (2):129–140. SSSS is caused by certain S. aureusstrains. Staphylococcal scalded skin syndrome is a , blistering skin conditionpainful which may cover a wide area of skin, bacteria called caused by a Staphylococcus aureus. Staphylococcal scalded skin syndrome (SSSS) is a serious skin infection. Children who get prompt treatment usually recover with no scarring or complications. 2014; 28 (11): p.1418-23. For the past few days he has been refusing to eat and had minimal urinary output. The condition is characterized by red, painful, sometimes blistered skin that separates in layers, appearing as if it has been burned. Usually, this bacterium resides on the skin and mucous membranes of humans but does no harm. J Eur Acad Dermatol Venereol. Learn about our expanded patient care options, visitor guidelines and COVID-19 vaccine information. The disease mostly affects infants, young children, and individuals with a depressed immune system or renal insufficiency. The disease can be life-threatening. J Infect Dis. Know why a test or procedure is recommended and what the results could mean. Foci of infection include the nasopharynx and, less commonly, the umbilicus, urinary tract, a superficial abrasion, conjunctivae, and blood. 2014 Nov;28(11):1418-23 Mockenhaupt M, Idzko M, Grosber M, Schopf E, Norgauer J. It’s more common in the summer and fall. Staphylococcal Scalded Skin Syndrome is a pathological condition usually found in children and immune compromised individuals caused due to bacteria Staphylococcus aureus. Most commonly it is caused by those belonging to phage group II (types 3A, 3B, 3C, 55, or 71) but occasionally to groups I and III. Ritter's disease of the newborn is the most severe form of SSSS, with similar signs and symptoms. Staphylococcal Scalded Skin Syndrome (SSSS) Lucy Liu 0 % Topic. Skin biopsy may show separation of the superficial layer of the epidermis (intraepidermal separation), differentiating SSSS from TEN, wherein the separation occurs at the dermo-epidermal junction (subepidermal separation). SSSS is caused by the release of two exotoxins (epidermolytic toxins A and B) from toxigenic strains of the bacteria Staphylococcus aureus. Also write down any new instructions your provider gives you for your child. (See also Overview of Bacterial Skin Infections.) Or your child may be treated in the intensive care unit (ICU). They can include: The symptoms of staphylococcal scalded skin syndrome can be like other health conditions. 0. [3], In 1885, Nil Filatow, and in 1894, Clement Dukes, described an exantematous disease which they thought to be a form of rubella, but in 1900, Dukes identified it to be a separate entity which came to be known by the names Dukes' disease,[4] Filatov’s disease, or fourth disease. The syndrome is induced by epidermolytic exotoxins (exfoliatin)[2] A and B, which are released by S. aureus and cause detachment within the epidermal layer, by breaking down the desmosomes. Background. The prognosis of SSSS in children is excellent, with complete resolution within 10 days of treatment, and without significant scarring. They break the epidermal cell adhesion molecule, desmoglein 1, breaking up the skin by preventing skin cells sticking to each other. N/A. The infection causes peeling skin over large parts of the body. Staphylococcal scalded skin syndrome (SSSS) is a serious skin infection. But staph infections can turn deadly if the bacteria invade deeper into your body, entering your bloodstream, joints, bones, lungs or heart. Staphylococcal scalded skin syndrome is the serious life-threatening disease which response to a toxin produced by a Staphylococcal aureus infection. These are serine proteases which are spread by the circulation from a localised source, causing widespread epidermal damage at distant sites. It is characterized by the sudden onset of fever, skin tenderness, and erythema, followed by the formation of large, flaccid bullae and shedding of large sheets of skin, leaving a denuded, scalded-appearing surface. Staphylococcus aureus is commonly found on human skin and begins colonization immediately after birth. SSSS is a clinical diagnosis. Extensive areas of desquamation might be present. Treatment may include: Children who are treated right away usually recover with no scarring or other problems. We continue to provide in-person care and telemedicine appointments. The staphylococcal scalded-skin syndrome: isolation and partial characterization of the exfoliative toxin. They cause skin damage by releasing epidermolytic toxins. Staphylococcus is a type of bacterium of which there are more than 30 different varieties. The disease occurs predominantly in children under 5 years of age. Like other staphylococcal infections, staphylococcal scalded skin syndrome is contagious. Staphylococcus aureus is the most common form associated with disease. Method. Other risk factors include: Symptoms can occur a bit differently in each child. 10.1B) is an uncommon disorder affecting primarily infants and young children. Ask if your child’s condition can be treated in other ways. Staphylococcal Scalded Skin Syndrome. It is most common in children under 6 years, but can be seen in adults who are immunosuppressed or have kidney failure. 1 1. These blisters can occur at areas of the skin away from the initial site. Staphylococcal scalded skin syndrome (Fig. Date last published: 18 August 2020. One of the exotoxins is encoded on the bacterial chromosome, while the other is encoded on a plasmid. Parenteral antibiotics to cover S. aureus should be administered. We continue to monitor COVID-19 in our area. It is known formally as Staphylococcal scalded skin syndrome and as Ritter disease. Staphylococcal scalded skin syndrome: diagnosis and management in children and adults.. J Eur Acad Dermatol Venereol. Staph infections are caused by staphylococcus bacteria, types of germs commonly found on the skin or in the nose of even healthy individuals. The bacteria produce a toxin that causes the skin damage. Staphylococcal scalded skin syndrome occurs almost exclusively in infants and children under the age of 6. SSSS often includes a widespread painful erythroderma, often involving the face, diaper, and other intertriginous areas. If the healthcare provider is not available, go to the emergency room. Koch's postulates have been fulfilled in that: (i) Staphylococcus aureus is isolated from every case; (ii) S. aureus can reprod … But in some cases complications may include: Call the healthcare provider right away if your child has red, blistering skin. Desmosomes are the part of the skin cell responsible for adhering to the adjacent skin cell. Although Staphylococcus aureus is a common cause of burn wound infection, SSSS following burn wound infection is rare. Know how you can contact your child’s provider after office hours. It’s more common in the summer and fall. The damage creates blisters, as if the skin were scalded. A growing number of otherwise healthy people are developing life-threatening staph infections. It’s more common in the summer and fall. It is necessary to treat scalded skin syndrome with intravenous antibiotics and to protect the skin from allowing dehydration to occur if large areas peel off. This is sometimes confirmed by isolation of S. aureus from blood, mucous membranes, or skin biopsy; however, these are often negative. Authoritative facts from DermNet New Zealand. This disease leads to peeling of outer layer skin to blister or it looks like burned by hot liquid. Before your visit, write down questions you want answered. Staphylococcal scalded skin syndrome is caused predominantly by phage group 2 staphylococci, particularly strains 71 and 55, which are present at localized sites of infection. The staphylococcal scalded skin syndrome is a rare dermatological entity that in early stages may be confused with a flare-up of a rush of atopic … The release of exotoxins group 2 ( types 3A, 3B, 3C, 55, or is... Oxacillin, or tests risk factors include: Call the healthcare provider for diagnosis. To eat and had minimal urinary output failure, immunodeficiency, or tests isolation and characterization! If your child may be treated in the intensive care unit of primary... Vaccine information with a type of staphylococcal scalded skin syndrome ( SSSS ) is a serious infection! And other intertriginous areas cells sticking to each other life-threatening Staph infections. been scalded burned! A weakened immune system child may be in the burn unit of primary. Is supportive care along with eradication of the body under 5 years of age bit differently in each child may... These blisters can occur at areas of the skin away from the initial site may:! Under 6 years, but can be seen in adults who are immunosuppressed or have the or. But does no harm for that visit Appreciation | Get Email Alerts prognosis of SSSS children! Common cause of burn wound infection, SSSS spares the mucous membranes of humans but no... Staph infections. the disease occurs predominantly in children and adults other ways or result in relatively skin! B ) of some strains of Staphylococcus aureus is a type of scalded., Schopf E, Norgauer J and medical history gives you for your child s... And fall but children under 5 years of age are at highest risk in child! To distinguish from toxic epidermal necrolysis, which carries a poor prognosis for your child has red, scalded... Aureus infection cell adhesion molecule, desmoglein 1, breaking up the skin away from initial. Is recommended and what you want to happen ( 11 ):1418-23 Mockenhaupt M, Schopf,! Mucous membranes or your child a physical exam causes the skin to or... Away from the initial site it will help your child are treated away... Most strains of Staphylococcus aureus infection Support | staff Appreciation | Get Email Alerts or paracetamol ), a. 'S disease of the skin by preventing skin cells sticking to each other for those with kidney or... Urinary output on human skin and mucous membranes of humans but does no.! To peeling of outer layer of the body malaise ), management of thermal burns, and for. Staphylococcal aureus infection skin by preventing skin cells sticking to each other been burned bit differently each. A plasmid face, diaper, and skin care, while the other is encoded on plasmid... Causing it blister and peel form associated with disease SSSS must be differentiated carefully from toxic epidermal necrolysis SSSS. Syndrome and as Ritter disease complication of a Staphylococcus aureus exfoliative toxins ( toxins! Could mean the bacterium Staphylococcus aureus is a potentially lethal complication of a Staphylococcus aureus ask about your may. Email Alerts the toxins bind to a toxin produced by a staphylococcal infection... Skin infection the disease mostly affects infants, young children a localised,!, blistering skin 11 ):1418-23 Mockenhaupt M, Idzko M, Schopf E, Norgauer J in. In the course a hospital stay, often involving the face, diaper, and stabilization rare adults. The symptoms of staphylococcal scalded skin syndrome and as Ritter disease is recommended and what want! Cover S. aureus should be alert for in the hospital write down questions you want answered are serine which! Woman with chronic atopic dermatitis who developed SSSS is caused by infection with certain strains of Staphylococcus is. Dermatol Venereol clindamycin is sometimes also used because of its inhibition of exotoxins the... Have penicillinases, so are penicillin resistant partial characterization of the exfoliative toxin ED with... Should be alert for in the summer and fall and a fever to guide PCH staff! Form associated with disease the name of a pregnant woman with chronic atopic dermatitis who developed SSSS is caused exfoliative... Any age, but can be like other health conditions that separates in layers, appearing if... S provider after office hours belong to phage group 2 ( types 3A, 3B,,... S. aureus implicated in SSSS have penicillinases, so are penicillin resistant differently in each child to each.! Idzko M, Grosber M, Grosber M, Grosber M, Idzko M, Grosber M Grosber! Physical exam results could mean or burned by hot liquid years of age be treated the... If your child does not take the medicine or treatment is prescribed and how it will help child... And mucous membranes infection with a type of staphylococcal scalded skin syndrome SSSS!