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.
• 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

Symptoms begin with an isolated, crusted infection that may look like impetigo (see Bacterial Skin Infections: Impetigo). 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, scarlet-colored areas appear around the crusted area within a day of the beginning of infection. These areas may be 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 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 another 1 to 2 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 what doctors call superinfections. Also, critical amounts of fluid can be lost because of oozing and evaporation, resulting in dehydration.

Diagnosis and Treatment

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 perform 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) are sent to the laboratory to be cultured for bacteria.

Treatment is with antibiotics for at least a week. Local wound care with topical emollients soothes the skin and protects it from drying out.

Last full review/revision October 2007 by A. Damian Dhar, MD, JD