Staphylococcal scalded skin syndrome

Staphylococcal scalded skin syndrome may occur as outbreaks in hospital nurseries. It may occur without fever. The rash feels like sandpaper and tends to be more prominent at flexor creases. Sterile bullae may form. Most children appear well and not "toxic." Sepsis is a potential complication.

CASES/YEAR
30 (US); 600 (Global)
CATEGORY
Childhood Infections
AGENT TYPE
Bacteria
OTHER NAMES
SSSS; Ritter's disease;
ACUITY
Acute-Moderate
INCUBATION
4-10 days; [CCDM, p. 575]
INITIAL SYMPTOMS
Diffuse erythematous rash;
PRECAUTIONS
Contact for duration of illness; "Consider healthcare personnel as potential source of nursery, NICU outbreak." [CDC 2007 Guideline for Isolation Precautions]
COMMENTS
A disease of infants and children, outbreaks of staphylococcal scalded skin syndrome occur in hospital nurseries. It may occur without fever. The disease is rare in adults, but may affect immunosuppressed patients. The rash feels like sandpaper and tends to be more prominent at flexor creases. Sterile bullae may form, and diffuse exfoliation of the epidermis (desquamation) occurs. Most children appear well and not "toxic." Sepsis is a potential complication. [King R, de Saint Victor, P. Staphylococcal Scalded Skin Syndrome. Updated 8/10/01. e-Medicine] A frozen section of the epidermis can rapidly distinguish SSSS from the more serious toxic epidermal necrolysis (TEN). Mortality is less than 4% in treated children. Nikolsky's sign (the separation of the epidermis after light stroking of the skin) is positive in SSSS. The skin heals within 10-14 days. [PPID, p. 811] The palms/soles and mucous membranes are spared. [Cecil, p. 2629]
DIAGNOSTIC
Clinical; Gram stain; Culture;
SCOPE
Global
SIGNS & SYMPTOMS
  • >fatigue, weakness
  • >fever
  • S rash (exanthem)
  • S skin blister or vesicles
  • *sepsis
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Skin or Mucous Membranes (Includes Conjunctiva)
SOURCE
Person-to-Person
RESERVOIR
Human
RISK FACTORS
TREATMENT
Start IV naficillin followed by oral cloxacillin. Consider vancomycin in areas with methicillin-resistant S. aureus or if lack of response to initial therapy. [Merck Manual, p. 1001]
DRUG LINK
Merck Manual: Staphylococcal Scalded Skin Syndrome
REFERENCES FOR CASES/YEAR
1. (US) A study in Germany found a rate of about 1 case per 10 million; [Mockenhaupt2005: PMID 15816826] Use 1 case/10 million X 300 million = 30;
2. (Global) Estimate global cases/yr at 20 X US cases/yr;