Scalded skin syndrome

• Alternative Names

  Ritter disease; Staphylococcal scalded skin syndrome (SSS)

• Causes, incidence, and risk factors

  Scalded skin syndrome is caused by infection with certain strains of bacteria in the Staphylococcus family. During the infection, the staphylococci produce a poison that causes the skin damage. The damage creates blisters as if the skin were scalded.

  Scalded skin syndrome is found most commonly in infants and children under the age of 5.

• Symptoms
  • Blisters
  • Fever
  • Large areas of skin peel or fall away (exfoliation or desquamation)
  • Painful skin
  • Redness of the skin (erythema), which spreads to cover most of the body
  • Skin slips off with gentle pressure, leaving wet red areas (Nikolsky's sign)
• Signs and tests
  • Positive Nikolsky's sign (skin slipping off when rubbed)

  Tests include:

  • Complete blood count (CBC)
  • Cultures of the skin and throat
  • Electrolyte test
  • Skin biopsy (done only in rare cases, such as when the skin condition may be due to a drug reaction known as toxic epidermal necrolysis or TEN)
• Treatment

  Intravenous antibiotics for staphylococcus are given to help fight the infection. Because much fluid is lost through the open skin, it's important to get intravenous fluid to prevent dehydration.

  Moist compresses to the skin may improve comfort. You can apply an emollient to keep the skin moist. Healing begins about 10 days after treatment.

• Expectations (prognosis)

  The prognosis is usually excellent. A full recovery is expected.

• Complications
  • Fluid regulation problems causing dehydration or electrolyte imbalance
  • Poor temperature control (in young infants)
  • Severe bloodstream infection (septicemia)
  • Spread to deeper skin infection (cellulitis)
• Calling your health care provider

  Call your health care provider or go to the emergency room if you have symptoms of this disorder.

• Prevention

  The disorder may not be preventable. Treating any staphylococcus infection quickly can help.

• References

  Korman NJ. Macular, papular, vesiculobullous, and pustular diseases. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 465.

Review Date: 12/1/2009

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.