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Staphylococcal Scalded Skin Syndrome

by A. Damian Dhar, MD, JD

Staphylococcal scalded skin syndrome is a reaction to a staphylococcal skin infection in which the skin blisters and peels off as though burned.

  • In addition to the blistered, peeling skin, the person has fever, chills, and weakness.

  • The diagnosis is based on the appearance of the skin, but sometimes a biopsy is done.

  • With timely treatment, the prognosis is excellent.

  • Treatment involves antibiotics given intravenously.

Certain types of staphylococci bacteria secrete toxic substances that cause the top layer of the epidermis to split from the rest of the skin. Because the toxin spreads throughout the body, staphylococcal infection of a small area of skin may result in peeling over the entire body. Staphylococcal scalded skin syndrome occurs almost exclusively in infants and children under the age of 6. It rarely occurs in older people except for those with kidney failure or a weakened immune system. Like other staphylococcal infections, staphylococcal scalded skin syndrome is contagious.


Symptoms begin with an isolated, crusted sore that may look like impetigo (see Impetigo and Ecthyma). In newborns, the infection may appear in the diaper area or around the stump of the umbilical cord. In older children, the face is the typical site of infection. In adults, the infection may begin anywhere. In all people with this disorder, the skin around the crusted sore becomes scarlet in color within 24 hours. These areas are painful. The skin may be extremely tender and have a wrinkled tissue paper–like consistency. Then, other large areas of skin distant from the initial infection, frequently areas of friction, such as skinfolds, and on the buttocks, hands, and feet, redden and develop blisters that break easily.

The top layer of the skin then begins peeling off, often in large sheets, with even slight touching or gentle pushing. The peeled areas look scalded. Within 2 to 3 days, the entire skin surface may be involved, and the person becomes very ill with a fever, chills, and weakness. With the loss of the protective skin barrier, other bacteria and infective organisms can easily penetrate the body, causing infections in those areas and in other areas, sometimes spreading through the bloodstream (sepsis). Also, critical amounts of fluid can be lost because of oozing and evaporation, resulting in dehydration.


A diagnosis is made by the appearance of skin peeling after an apparent staphylococcal infection. If no signs of staphylococcal infection are observed, doctors often do a biopsy, in which a small piece of skin is removed and sent to the laboratory to be tested. Swabs taken from the nose, the thin mucous membrane that covers the eyes (conjunctiva), the throat, and the nasal passages and upper throat (nasopharynx), samples of blood and urine, and samples taken from the area where doctors think the infection started (such as the umbilical cord or skin) are sent to the laboratory to be cultured for bacteria.

Prognosis and Treatment

With prompt diagnosis and treatment, staphylococcal scalded skin syndrome rarely causes death. The topmost layer of the skin is quickly replaced, and healing usually occurs within 5 to 7 days after start of treatment.

Treatment is with antibiotics given by vein and later by mouth. Doctors give people who have a widespread infection and oozing sores the same treatment they give to people who have been burned (see Severe burns). Skin moisturizers (emollients) may be used to help protect the skin after it has healed.

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