One of Doc’s cases during the pediatric rotation involved a baby hospitalized with a condition I’d never heard of. Staphylococcal scalded skin syndrome (SSSS). And he showed me pics of the poor baby. He looked like he’d be dipped in boiling water. Angry, red, peeling skin. As a parent or grandparent, I’d be freaking out. And even more so in TEOTWAWKI if there were no advanced care available.
SSSS is a rare, severe, superficial blistering skin illness where the outer layer of skin, the epidermis, detaches due to an endotoxin release by a specific strain of Staphylococcus aureus. It is also known as Ritter disease, especially when it affects newborns.[1] [2]
RISK FACTORS
SSSS most frequently affects children under the age of 5 years, especially 2-3 year-olds.[3] [4] [5] It’s thought to be due to an immature immune system and/or immature renal clearance system.[6] Older children and adults with this condition are often immunosuppressed or affected by chronic renal disease. [7] [8] It is more common in the summer and fall months.[9]
CAUSE
SSSS begins as a localized toxigenic staph infection (about 5% of staph strains).[10] [11] The disease may be contained to a small area of the skin, or the entire body may be involved. It most often begins around the ears, eyes, or throat, or at an infected wound.[12]
SIGNS AND SYMPTOMS
SSSS usually begins with nonspecific symptoms in children: irritability, lethargy, fever.[13] Within 24-48 hours a painful, widespread red rash develops, followed by the formation of large, fluid-filled blisters that rupture easily. These blisters develop most commonly on the face, armpits, buttocks, and groin. The fluid may range from sterile and cloudy liquid to a yellow pus.[14]
The red rash usually begins on the face, neck, armpits, and groin, and then spreads quickly to other parts of the body. In newborns, lesions often develop around the umbilical cord.[15] [16]
TREATMENT
Children diagnosed with SSSS often recover completely without complications if treatment begins quickly. The mortality rate is low in this group, 1-5%, unless complications arise. In adults, the mortality rate is 50-60%, generally due to an underlying condition which itself increases the predisposition to complications.[17] [18] Among adults, it is also 2-4 times more common in men. (Though not explicitly stated, it's predominantly in homosexual men. Also more common in those with HIV.) [19]
- Modern treatment includes hospitalization and IV antibiotics (flucloxacillin, ceftriaxone, clarithromycin, cefazolin, nafcillin, oxacillin, or vancomycin)[20]
- A nasogastric tube may be inserted to help replace fluids.[21] [22]
- If the patient responds well, treatment is continued at home with oral antibiotics.[23]
- Mild cases may be managed as follows:
- Cephalexin or dicloxacillin, 500 mg, 4x per day OR
- SMZ-TMP, 160/800 mg, 2x per day
- Use Tylenol and ibuprofen or morphine for pain relief.[24] [25] However, the NCBI advises against using ibuprofen due to the risk of kidney impairment[26]
- Vancomycin is recommended in the case of hospital-acquired infections[27]
- Do not use clindamycin as about 50% of strains are resistant to this antibiotic[28]
- Monitor fluids to prevent dehydration in young children and those with widespread blisters.[29]
- Wash the skin daily with soap substitutes
- Apply petroleum jelly and/or burn dressings to afflicted areas to promote healing and reduce heat loss[30] [31]
COMPLICATIONS
- Scarring[32]
- Dehydration[33] [34] [35]
- Acute kidney injury[36]
- Hypothermia[37] [38]
- Secondary infections (sepsis, cellulitis, pneumonia)[39] [40]
- Renal failure[41]
[1] https://dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome
[2] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[3] https://dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome
[4] https://www.hopkinsmedicine.org/health/conditions-and-diseases/staphylococcal-scalded-skin-syndrome
[5] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[6] https://www.hopkinsmedicine.org/health/conditions-and-diseases/staphylococcal-scalded-skin-syndrome
[7] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[8] https://dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome
[9] https://www.hopkinsmedicine.org/health/conditions-and-diseases/staphylococcal-scalded-skin-syndrome
[10] https://dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome
[11] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[12] https://dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome
[13] https://www.hopkinsmedicine.org/health/conditions-and-diseases/staphylococcal-scalded-skin-syndrome
[14] https://dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome
[15] https://dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome
[16] https://www.hopkinsmedicine.org/health/conditions-and-diseases/staphylococcal-scalded-skin-syndrome
[17] https://dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome
[18] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[19] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[20] https://dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome
[21] https://www.hopkinsmedicine.org/health/conditions-and-diseases/staphylococcal-scalded-skin-syndrome
[22] https://www.hopkinsmedicine.org/health/conditions-and-diseases/staphylococcal-scalded-skin-syndrome
[23] https://dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome
[24] https://dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome
[25] https://www.hopkinsmedicine.org/health/conditions-and-diseases/staphylococcal-scalded-skin-syndrome
[26] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[27] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[28] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[29] https://dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome
[30] https://dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome
[31] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[32] https://www.hopkinsmedicine.org/health/conditions-and-diseases/staphylococcal-scalded-skin-syndrome
[33] https://www.hopkinsmedicine.org/health/conditions-and-diseases/staphylococcal-scalded-skin-syndrome
[34] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[35] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[36] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[37] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[38] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[39] https://www.hopkinsmedicine.org/health/conditions-and-diseases/staphylococcal-scalded-skin-syndrome
[40] https://www.ncbi.nlm.nih.gov/books/NBK448135/
[41] https://dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome
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