Staphylococcal Scalded Skin Syndrome

Staphylococcal scalded skin syndrome is a painful, blistering skin condition which may cover a wide area of skin, caused by a bacteria called Staphylococcus aureus. This syndrome produces a toxin that damages the outer layer of the skin, causing it to blister and peel. The affected skin initially looks red, resembling a scald or burn, and is very tender to touch, so the condition is called the staphylococcal scalded skin syndrome.

Staphylococcus aureus is the most common bacteria to infect the skin, eyes, and nose. For example, it is the usual cause of • impetigo • boils and abscesses • styes and conjunctivitis • infections in grazes and wounds • infections in skin conditions such as eczema.  Only 5% of Staphylococcus aureus produces proteins that are toxic to the skin. It is that bacterial toxin that causes the skin to detach and then peel and form a crust. The condition is more common in neonates and children younger than five years.

This condition is because they may not have the protective antibodies against these toxins as their immune system has not yet developed a natural protection against bacteria that older children and adults have. Staphylococcal scalded skin syndrome is rare in adults but can affect those who have chronic kidney disease and immunodeficiency, those on immunosuppressant drugs, or undergoing chemotherapy.

As staphylococcus bacteria is carried naturally in the nose (up to 80%), throat or mouth without causing illness, it is easily passed from person to person on their hands, towels, and droplets from either coughing or sneezing.

The original source of infection may be relatively minor, for example, an infected graze, nappy rash, or a red sticky eye. After a few days, a widespread patchy red rash appears with little blisters, and then the patches rapidly join up to cover most of the skin surface. 

Often the pain is the first symptom, and there is little to be seen on the skin.

Affected children may be miserable, lethargic (lacking energy), feverish, and not want to be held or touched. 

Gentle pressure on the skin can cause it to peel, leaving painful raw patches

If large areas of a skin peel, body fluids and salts can be lost, causing dehydration, and further infection may enter the bloodstream. It does not affect the mouth or the eyes. 

The diagnosis is often made from the typical appearance of the skin and the symptoms. Skin swabs may be taken from the source of infection and blister fluid to confirm the presence of the

Staphylococcal bacteria and, in some cases, blood tests will also be taken and tested for an infection. It is sometimes necessary for a small piece of skin to be sent for microscopic examination to exclude other causes for the blisters.

Yes. The earlier treatment is started, the higher the chance of a cure reducing the risk of widespread infection. Once cured, there is no visible difference (scarring) or lasting effects on the skin.

Usually, antibiotics will need to be given intravenously through a drip or cannula (small tube) inserted into a vein for a day or two. Once recovery has started, treatment is then changed to an oral antibiotic, usually for another 5 to  8 days. If the infection is caught early, it can sometimes be treated with oral antibiotics straightaway, and intravenous antibiotics can be avoided.

Simultaneously, as taking antibiotics, the skin needs to be gently cleaned at least once a day with a soap substitute, which may contain an antiseptic.

Greasy moisturizers are recommended to soothe the skin, aid healing, and stop the healing skin from sticking to clothing or bedding.

In some cases, it may be necessary to treat the area with burns dressings. Pain relief is essential for paracetamol, ibuprofen, and oral morphine to keep pain under control while the skin heals.