Overview of Staphylococcal Scalded Skin Syndrome:
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The most common causes of generalized desquamation and systemic illness in older patients are toxic epidermal necrolysis (TEN) and staphylococcal scalded skin syndrome (SSSS) in infants and young children (and occasionally in immunocompromised adults).
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It is diagnosed by performing a biopsy and culture of the conjunctiva, nasopharynx, blood, urine, and areas of potential primary infection, such as the umbilicus and suspicious skin lesions.
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Patients should be treated with antistaphylococcal antibiotics and, if the disease is widespread, preferably in a burn unit.
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Complications similar to those seen with burns should be monitored and treated.
What Is Staphylococcal Scalded Skin Syndrome?
Staphylococcal scalded skin syndrome (SSSS), also known as Ritter disease, is a skin disease caused by exotoxin-producing strains of the Staphylococcus species, usually from a distant site. It usually appears 48 hours after birth and is uncommon in children above six years.
Staphylococcal scalded skin syndrome is an illness characterized by red blistering skin that resembles a burn or scald, hence the name. The release of two exotoxins (epidermolytic toxins A and B) from toxigenic strains of the bacteria Staphylococcus aureus causes SSSS. Desmosomes are the parts of the skin cell that are responsible for adhering to the skin cell next to it. Toxins bind to a molecule within the desmosome called Desmoglein 1 and break it down, allowing skin cells to move. When it appears in newborns or young infants, SSSS is also known as Ritter disease or Lyell disease.
What Are the Symptoms of Staphylococcal Scalded Skin Syndrome?
Early symptoms of staphylococcal scalded skin syndrome are typically accompanied by the following infection-related symptoms:
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Fever and irritability.
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Fatigue and chills.
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Weakness.
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A loss of appetite.
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Conjunctivitis (an infection or inflammation of the clear lining that covers the white part of the eyeball).
Patients can also notice the formation of a crusty sore. In newborns, the sore usually appears in the diaper area or around the stump of the umbilical cord, and in children, it appears on the face. It can appear anywhere with adults. As the toxin is released, the skin becomes red, and tender, either limited to the bacteria's entry point or become widespread. They are easily broken blisters and the peeling skin can come off in a large sheet.
Who Is Susceptible to Staphylococcal Scalded Skin Syndrome?
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Staphylococcal scalded skin syndrome is most common in children under the age of five, particularly neonates (newborn babies). Because lifelong antibodies against staphylococcal exotoxins are typically acquired during childhood, SSSS is much less common in older children and adults.
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Neonates are especially vulnerable due to a lack of specific immunity to the toxins and an immature renal clearance system (toxins are primarily removed from the body via the kidneys).
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Immunocompromised people and people with renal failure, regardless of age, may be at risk of SSSS.
How Does Staphylococcal Scalded Skin Syndrome Occur?
Staphylococcal scalded skin syndrome is caused by a localized staphylococcal infection that produces the two causative exotoxins (epidermolytic toxins A and B). SSSS outbreaks are common in childcare facilities. The bacteria are introduced into the nursery by an asymptomatic adult carrier of Staphylococcus aureus. About 15 % to 40 % of healthy people are carriers of Staphylococcus aureus, which means they have the bacteria on their skin but show no signs of infection or disease. On the other hand, Staphylococcal skin infections are common in infants and young children, implying an increased risk of SSSS. Staphylococcus aureus is also commonly found in the throat, ear, and eye infections.
How Is Staphylococcal Scalded Skin Syndrome Diagnosed?
Diagnosis of SSSS depends on:
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History and physical examination.
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Tzanck smear.
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Skin biopsy, which shows intraepidermal cleavage at the granular layer.
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Bacterial culture from skin, blood, urine, or umbilical cord sample (in a newborn baby).
How Is Staphylococcal Scalded Skin Syndrome Treated?
Death is rare with prompt diagnosis and treatment. The stratum corneum is quickly replaced, and healing usually occurs within five to seven days of starting treatment.
Antibiotic Treatment:
Although, the treatment of staphylococcal scalded skin syndrome usually necessitates hospitalization, particularly in burn units, because intravenous antibiotics are usually required to eradicate the staphylococcal infection.
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Flucloxacillin, a penicillinase-resistant antistaphylococcal antibiotic, is used.
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Nafcillin, Oxacillin, Cephalosporin, and Clindamycin are some other antibiotics.
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Vancomycin is used to treat infections where Methicillin resistance is suspected (MRSA).
Oral antibiotics can be substituted within a few days, depending on the response to treatment. The patient may be discharged from the hospital to continue his or her treatment at home. Corticosteroids provide slow healing and are therefore not given to SSSS patients.
Supportive Treatments:
Other supportive treatments for SSSS include:
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Medications for fever and pain as needed.
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Fluid and electrolyte intake must be monitored and maintained.
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A proper skincare routine as the skin is often very fragile. To keep the skin moisturized and protected, apply petroleum jelly or other creams.
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Newborn babies with SSSS are typically kept in incubators.
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Although the outward signs of SSSS appear to be severe, children generally recover well, and healing is usually complete. Dehydration can occur as the blisters drain and ooze. Patients are advised to stay hydrated. Healing typically begins 24 to 48 hours after treatment begins and is completed within five to seven days. Complete recovery is seen five to seven days later.
What Are the Complications of Staphylococcal Scalded Skin Syndrome?
If treated promptly, most people with staphylococcal scalded skin syndrome recover with no problems or skin scarring. The same bacterium that causes SSSS, however, can also cause pneumonia, cellulitis (an infection of the skin's deep layers, as well as the fat and tissues beneath it), and sepsis (a bloodstream infection). These conditions can be life-threatening, making prompt treatment even more critical.
Conclusion:
Staphylococcal scalded skin syndromeis extremely rare. It can be serious and painful, but it is rarely fatal. With prompt treatment, most people recover completely and quickly, with no long-term side effects or scarring. If the symptoms of SSSS are noticed, one should consult their doctor immediately.
