Staphylococcal Scalded Skin Syndrome – Pictures, Treatment

What Is SSSS?

SSSS or Staphylococcal Scalded Skin Syndrome is a skin condition caused by toxic strains of the bacteria, Staphylococcus Aureaus. This skin condition is characterized by painful and widespread erythema, blistering and its hallmark sign; exfoliation.

What Causes SSSS?

The primary causative agent for SSSS is the bacteria Staphylococcus aureaus. Specific strains that cause Staphylococcal Scalded Skin Syndrome are the following:

  • Type 3A
  • Type 3B
  • Type 3C
  • Strain 55 and 71

The toxin from these bacterial strains cause the signs and symptoms seen in SSSS. These toxins are:

  • Epidermolytic toxin A (ET-A)
  • Epidermolytic toxin B (ET-B)

Signs and Symptoms of Staphylococcal Scalded Skin Syndrome

The following pathological changes are suggestive of SSSS or Staphylococcal Scalded Skin Syndrome:

  • Sudden onset of fever
  • Erythematous rash seen on the face, trunk, and extremities
  • Presence of fluid filled blisters that enlarge and then exfoliate or slough off
  • Presence of pain particularly on the erythematous areas
  • Irritability
  • Weakness
  • Crusting on the periorificial areas (around the mouth and eyes) with prominent presentation
  • Presence of conjunctivitis, pharyngitis, or erosions on the mouth or lips
  • Sandpaper-like texture of the skin
  • Formation of skin wrinkles and bullae (fluid filled vesicles) within 24-48 hours
  • Rash or redness of the skin surrounding orifices such as the eye and the mouth (periorificial area)
  • Shedding or exfoliation of the skin, which is then removed and reveals red, moist and a scalded skin appearance
  • The borders of the scalded or exfoliated skin appears like rolled wet tissue
  • Desquamation of scalded areas last for three to five days
  • Possible shedding of hair and nails in some cases

Pathophysiology of Staphylococcal Scalded Skin Syndrome

As previously stated, SSSS is primarily caused by the toxic strains of Staphylococcus aureaus. These strains release the exotoxins epidermolytic toxins A and B. These toxins interact with the skin cells causing significant damage and pathologic changes seen in Staphyloccoal Scalded Skin Syndrome. Here is a summary of the pathophysiological process occurring from this disease:

  • The disease begins from exposure to the causative agent or the bacteria. Exposure may begin from an existing infection such as conjunctivitis, pharyngitis, skin lesions, etc.
  • The infection may also begin in the event that a person’s immune system becomes weak, thereby causing the staphylococci bacteria to proliferate in greater number, overwhelming the body’s natural defenses.
  • The bacteria then releases the toxins (epidermolytic toxin A and B) which attack the desmosomes (desmosomes are structures within the skin responsible for making the skin cells adhere to the adjacent cell).
  • The toxins enter the desmosomes and destroy the molecule Desmoglein 1. This molecule is responsible for giving the desmosome its ability to adhere to the neighboring skin cells.
  • Without the ability to adhere to the neighboring skin cells, the skin cells then become detached or “unstuck”. This then leads to the skin breaking and also the hallmark sign of exfoliating and scalding.

How Is SSSS Diagnosed?

Staphylococcal Scalded Skin Syndrome is diagnosed through culture and biopsy. This is the definitive process for diagnosis of SSSS and it helps rule out other skin infections with similar clinical presentation.

Skin Biopsy

This usually involves collecting skin samples from the affected areas and studying them microscopically.


Culture studies provide avenue for the identification of the microorganism causing the infection and the appropriate antibiotic the infection is sensitive to. This allows the physician to identify the appropriate antibiotic to be given and those that must not be given, since the microorganism might have a sensitivity to it. SSSS cultures may be obtained from the lesions, nasopharynx, conjunctiva, and feces. For children, cultures are often obtained from the skin, and blood cultures often have a positive result. The opposite goes for adults, which often have positive blood culture results.

Toxin Identification

Another diagnostic procedure to confirm the presence of SSSS is through identifying the toxins present. Toxin identification is done through the following procedures:

  • Enzyme Linked Immunosorbent Assay
  • Double Immunodiffusion
  • Slide Latex Agglutination

Treatment for Staphylococcal Scalded Skin Syndrome

SSSS is treated with the following:

Antibiotic Treatment

The primary goal of treatment for SSSS is to eradicate the causative agent. When the bacterium is eradicated, the toxin causing damage to the skin cells will also be eradicated. Antibiotic treatment is usually given intravenously. Penicillinase resistant, antistaphylococcal antibiotics are given; Cloxacillin, Oxacillin, Dicloxacillin, Methicillin, Nafcilllin or Flucloxacillin.

Cloxacillin is the current choice for treatment. Intravenous treatment is then followed by antibiotic treatment, usually given several days after completion of intravenous antibiotics.

Exchange Transfusion

Usually done to preterm infants with Staphylococcal Scalded Skin Syndrome.

Intravenous Immunoglobulin

This treatment helps the patient’s immune system by strengthening it and enabling it to fight the infection.

  • Lubrication of moist areas to decrease itchiness and tenderness.
  • Maintenance of proper hydration and electrolyte balance (especially for infants and young children).
  • Identification of other infected individuals (such as family members and health workers) to prevent further spread of the infection.
  • Reinforcement of measures that control infection such as proper hand washing and proper disposal of infected materials.

Staphylococcal Scalded Skin Syndrome Pictures

Staphylococcal Scalded Skin Syndrome

Staphylococcal Scalded Skin Syndrome picture (SSSS)Staphylococcal Scalded Skin Syndrome Image

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