Staphylococcal scalded skin syndrome is a complication of 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 and skin care.
With timely treatment, most children recover.
(See also Overview of Bacterial Skin Infections.)
Certain types of staphylococci bacteria secrete toxic substances that cause the top layer of the skin (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. However, most areas of peeling skin are not actually infected with the bacteria.
Staphylococcal scalded skin syndrome occurs almost exclusively in infants and children under the age of 6. It rarely occurs in older adults except for those with kidney failure or a weakened immune system.
Symptoms of Staphylococcal Scalded Skin Syndrome
Symptoms of staphylococcal scalded skin syndrome begin shortly after development of a staphylococcal infection such as impetigo. However, symptoms of impetigo are not always identified before staphylococcal scalded syndrome develops.
In newborns, the infection often begins in the diaper area or around the stump of the umbilical cord during the first few days of life.
In older children, the infection typically appears on the face.
In adults, the infection may begin anywhere.
In all people with this infection, a crusted sore develops on the skin. Within 1 day, the skin around the sore becomes red and painful. These symptoms quickly spread to other areas. The skin may be extremely tender and have a wrinkled tissue paper–like consistency.
Then, other large areas of skin that are not near the initial sore redden and develop large, thin blisters that break easily and start to peel. Blisters frequently develop in areas of friction, such as skinfolds, and on the buttocks, hands, and feet.
In this photo, the infant's skin is peeling off in large sheets after a staphylococcal infection.
This image shows staphylococcal scalded skin syndrome with superficial skin blistering caused by an infection with Staphylococcus aureus bacteria. This syndrome is rare in adults but can occur in those who have a weakened immune system or who have kidney failure or another chronic disease.
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, large areas of the skin surface may be involved, and the person may become 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.
Diagnosis of Staphylococcal Scalded Skin Syndrome
A doctor's evaluation
Sometimes a tissue biopsy and cultures
The diagnosis of staphylococcal scalded skin syndrome is made by the appearance of skin peeling after an apparent staphylococcal infection.
If no signs of staphylococcal infection are seen, doctors may do a biopsy, in which a small piece of skin is removed and sent to the laboratory to be tested.
Doctors take swabs 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 from the area where they think the infection started (such as the umbilical cord or skin) and send them to a laboratory to be cultured for bacteria. Doctors do other blood tests to look for toxins from the bacteria.
Treatment of Staphylococcal Scalded Skin Syndrome
Antibiotics
Treatment as for burns
People who have staphylococcal scalded skin syndrome are hospitalized. Doctors give them antibiotics by vein (intravenously) and later by mouth (orally). They also give large amounts of intravenous fluids to prevent dehydration.
Doctors give people who have a widespread infection and oozing sores the same treatment they give people who have been burned (see Severe burns), such as special wound care and dressings or bandages. If possible, people are treated in a burn unit.
Skin moisturizers (emollients, such as petroleum jelly) may be used to help maintain hydration in the skin.
Prognosis for Staphylococcal Scalded Skin Syndrome
With prompt diagnosis and treatment, the topmost layer of the skin is quickly replaced, and healing usually occurs within 5 to 7 days after start of treatment.
Staphylococcal scalded skin syndrome is fatal in less than 10% of treated children. However, it is fatal in up to about 60% of adults, even among those who have received treatment, because they often have 2 or more other diseases or medical conditions at the same time.
