Staphylococcal Scalded Skin Syndrome (SSSS) is a severe desquamating rash that affects infants.

Pathophysiology

• SSSS is caused by exotoxins released by Staphylococcus aureus, a bacteria that is commonly found in the skin flora of healthy adults. The exotoxins cleave desmoglein-1 resulting in splitting of the stratum granulosum and the formation of superficial blisters.

Clinical features

• It causes superficial fluid-filled blisters and often causes erythroderma (erythema of >90% of the body surface).
• There is desquamation (peeling of the epidermis) and Nikolsky sign is positive.
• Perioral crusting/fissuring is common and the oral mucosa is usually unaffected, unlike Toxic Epidermal Necrolysis (TEN).
• Due to the infective cause, fever and irritability are common.

Diagnosis

• Diagnosis is usually clinical, although a skin biopsy can be used to differentiate between SSSS and TEN.

Management

• Management is with intravenous antibiotics and supportive treatment.