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Scalded skin syndrome
Definition:
A disease of infants and young children (usually under 5 years of age) and whose classic symptom is damage to the skin with marked shedding (exfoliation).

Alternative Names:
Ritter disease; Staphylococcal scalded skin syndrome (SSS)

Causes, incidence, and risk factors:

Scalded skin syndrome is caused by infection with certain strains of a bacteria called staphylococcus. During the infection, the staphylococci produce a poison (exotoxin) that is responsible for the skin damage. Onset of the illness may be heralded by fever and skin tenderness. The effects of the toxin first produces reddening of the skin. Fluid collects beneath the skin loosening it. Subsequently, light rubbing of the skin may pull away large sheets of skin leaving a raw red base (a finding called the Nikolsky sign). These bare areas dry out and crust over.

It is found most commonly in infants and very young children.
Symptoms:
  • fever
  • 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)
  • large areas of skin peel or fall away (exfoliation or desquamation)
  • painful skin
  • infant appears quite ill
Signs and tests:

Tests include:

  • Complete blood count (CBC)
  • cultures of the skin and throat (often yield staphylococci)
  • skin biopsy (done only in rare cases where diagnosis is at question)
  • check of electrolytes to see if fluid loss has caused difficulties
Treatment:

Intravenous antibiotics that are specific for staphylococcus are given to help fight the infection. Because much fluid is lost through the open skin, supplemental intravenous fluid is important to prevent dehydration.

Moist compresses to the skin may improve comfort. An emollient may be applied to keep the skin moist. Healing begins in about 10 days following treatment.
Expectations (prognosis):

The prognosis is usually excellent. A full recovery is expected.

Complications:
  • severe bloodstream infection (septicemia)
  • fluid regulation problems causing dehydration or electrolyte imbalance
  • poor temperature control (in young infants)
  • spread to deeper skin infection (cellulitis)
Calling your health care provider:

Call your health care provider or go to the emergency room if symptoms of this disorder appear.

Prevention:

The disorder may not be preventable. Prompt treatment of any staphylococcus infection may be helpful.

Review Date: 3/1/2002
Reviewed By: Chayim Y. Newmark M.D., Department of Pediatrics, St. Louis Children's Hospital, St. Louis, MO. Review provided by VeriMed Healtchare Network.
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