What Is Scalded Skin Syndrome and What Causes It

Causality of SSSS

Staphylococcal scalded skin syndrome (SSSS), also known as Ritter’s disease, is a serious skin condition caused by certain strains of Staphylococcus aureus bacteria. It causes large, peeling blisters that look burnt or scalded. SSSS mostly affects infants and toddlers but may also affect adults with severely weakened immune systems.

Causes of SSSS

SSSS is a complication of a staph infection. It is caused by certain strains of S. aureus, a relatively common bacterium that frequently inhabits the eyes, ears, navel, and groin. While all strains of S. aureus produce toxins, only around 5% secrete specific types known as exfoliative toxins A and B (ETA and ETB). These are especially damaging to the skin and can lead to SSSS and a related, milder condition known as bullous impetigo.

ETA and ETB act like scissors, cutting away proteins called Desmoglein-3 that hold together the outermost layers of skin. The separation of these layers leads to the formation of large, thin blisters that erupt and peel away in sheets (desquamate).

In Children

SSSS mainly affects children under age 5 who, because of their age, have immature immune systems. Newborns are usually safe as they have naturally high levels of desmoglein-3 in their skin. But, within the first few weeks of birth, desmoglein-3 levels rapidly drop, increasing the risk of SSSS in infants and toddlers.

SSSS outbreaks are common in nurseries and day care centers due to the frequent skin-to-skin contact that can transmit the bacterium. These outbreaks tend to occur during cold and flu season, and are most common in autumn.

In Adults

SSSS is extremely rare in adults as most will have built up natural immune defenses to ETA and ETB. When SSSS does occur, it is almost always in immunocompromised people who lack these defenses, most especially those with:

• HIV/AIDS
• Cancer
• Organ transplants
• Chronic diseases

According to research, only around 1 in every 1 million adults in the United States gets SSSS each year. Unlike children, SSSS in adults is not influenced by season and can occur at any time.

Diagnosis

Although uncommon, a skin biopsy (removing a sample of skin for analysis in the lab) may be ordered if there is any doubt about the cause.

Treatment

The treatment of SSSS usually requires a hospital stay during which antibiotic drugs are administered intravenously. The choice of antibiotic can vary by the person’s age, such as:

• Children with SSSS are commonly treated with nafcillin or oxacillin six times daily or cephazolin three times daily.
• Adults with SSSS are commonly treated with vancomycin twice daily.

Intravenous fluids may also be used to treat dehydration caused by fluid loss. Severe dehydration in children can also be treated with a plasma transfusion (transferring the liquid portion of blood into a person).

Prognosis

If treated appropriately, full recovery from SSSS in children takes around two weeks. Adults with SSSS may take longer given their weakened immune state. Even so, most who recover do so with minimal or no scarring.

How to Prevent Exposure

The prevention of SSSS is focused on good hygiene to avoid exposure to Staphylococcus aureus. Most staph infections are caused by skin-to-skin contact with someone with S. aureus or objects they touched. This includes other kids in day care or caregivers in nurseries who handle babies.

To prevent getting and transmitting S. aureus:

• Wash your hands frequently with soap and warm water, including under your fingernails.
• Don’t share towels, sheets, or personal care items if someone in your household has a staph infection.
• Keep cuts, abrasions, or rashes clean and covered until they heal.
• Shower or bathe daily, including smaller children who return from day care.

Conclusion

Staphylococcal scalded skin syndrome (SSSS) is a serious skin condition caused when toxins from certain strains of Staphylococcus aureus cause the skin to blister and peel in sheets. It is most common in children under 5 but can also affect adults with compromised immune systems. SSSS is almost always treated in the hospital with antibiotics, IV fluids, wound care, and pain medications. Most treated individuals will recover without scarring. With that said, adults with SSSS are vulnerable to severe complications and are at far greater risk of death.

FAQs

Q: What is Staphylococcal scalded skin syndrome (SSSS)?
A: SSSS is a serious skin condition caused by certain strains of Staphylococcus aureus bacteria.

Q: Who is most affected by SSSS?
A: SSSS mostly affects children under 5 who have immature immune systems, but can also affect adults with severely weakened immune systems.

Q: How is SSSS diagnosed?
A: SSSS is mainly diagnosed by its appearance, although lab tests may be ordered to rule out other causes.

Q: How is SSSS treated?
A: SSSS is usually treated in the hospital with antibiotics, IV fluids, wound care, and pain medications.