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Scalded skin syndrome

Ritter disease; Staphylococcal scalded skin syndrome (SSS)

 

Scalded skin syndrome is a skin infection caused by bacteria in which the skin becomes damaged and sheds.

Causes

 

Scalded skin syndrome (SSS) is caused by infection with certain strains of Staphylococcus bacteria. The bacteria produce a toxin that causes the skin damage. The damage creates blisters, as if the skin were scalded. These blisters can occur;at areas of the skin away from the initial site.

SSS is found most commonly in infants and children under the age of 5.

 

Symptoms

 

Symptoms may include any of the following:

  • Blisters
  • Fever
  • Large areas of skin peel or fall away (exfoliation or desquamation)
  • Painful skin
  • Redness of the skin (erythema), which spreads to cover most of the body
  • Skin slips off with gentle pressure, leaving wet red areas (Nikolsky sign)

 

Exams and Tests

 

The health care provider will perform a physical exam and look at the skin. The exam may show that the skin slips off when it is rubbed (positive Nikolsky sign).

Tests may include:

  • Complete blood count (CBC)
  • Cultures of the skin, throat and nose, and blood
  • Electrolyte test
  • Skin biopsy (in rare cases)

 

Treatment

 

Antibiotics are given by mouth or through a vein (intravenously; IV) to help fight the infection. IV fluids are also given to prevent dehydration. Much of the body's fluid is lost through open skin.

Moist compresses to the skin may improve comfort. You can apply a moisturizing ointment to keep the skin moist. Healing begins about 10 days after treatment.

 

Outlook (Prognosis)

 

A full recovery is expected.

 

Possible Complications

 

Complications that may result include:

  • Abnormal level of fluids in the body causing dehydration or electrolyte imbalance
  • Poor temperature control (in young infants)
  • Severe bloodstream infection (septicemia)
  • Spread to deeper skin infection (cellulitis)

 

When to Contact a Medical Professional

 

Call your provider or go to the emergency room if you have symptoms of this disorder.

 

Prevention

 

The disorder may not be preventable. Treating any staphylococcus infection quickly can help.

 

 

References

Koch D, Taibjee SM. Staphylococcal scalded skin syndrome. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 223.

Paller AS, Mancini AJ. Bacterial, mycobacterial, and protozoal infections of the skin. In: Paller AS, Mancini AJ, eds. Hurwitz Clinical Pediatric Dermatology. 5th ed. Philadelphia, PA: Elsevier; 2016:chap 14.

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                Review Date: 12/10/2015

                Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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