Staphylococcal Scalded Skin Syndrome
Introduction
Staphylococcal scalded skin syndrome is a severe and life threatening skin condition where an affected child's skin looks like a burn or scald on the skin and is caused by a common bacteria known as Staphylococcus aureus.
This bacteria sits in healthy people's skin or nose.
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Child with peeling skin on ears, neck and shoulders from staphylococcal scalded skin syndrome
Who gets it?
This condition mainly occurs in children below the age of five, particularly in new-born children.
It is caused by Staphylococcus aureus or "staph" bacteria which sits in one third of healthy people's skin and nose without causing harm. An infection caused by staph bacteria is usually the trigger for this condition. These infections include school sores or impetigo (see impetigo fact sheet), infected eczema (see atopic dermatitis fact sheet), ear infections, boils and wound infections. In most cases though, a clear source of infection is not identified. When some babies and young children are exposed to the bacteria in early life, their immune system is too immature to defend against the toxins produced by the bacteria.
After children have been exposed to the toxin from the bacteria at least once, they can build tolerance. This is why this condition is less likely in older children. A child may be at an increased risk of this condition if their immune system is not at the same level of development as other children.
What causes it?
Staphylococcal scalded skin syndrome is caused by the bacterium Staphylococcus aureus (commonly shortened to "staph' or S.aureus). This bacteria releases two harmful toxins that break down the connections between our skin cells. Because the skin cells can no longer connect to each other properly, the skin starts to peel off. Some areas of skin may also swell up and blister, and these may eventually burst to leave red looking sores.
What does it look and feel like?
Looks like...
Areas of redness
Wrinkles that look like sandpaper
Blisters with fluid inside them, especially in the armpits, groin, ears and nose. These blisters may break down into sores that look like a burn
Skin that starts to peel when you gently stroke it
Feels like...
Episodes of fevers
Episodes of irritability (such as crying, sleeping for a longer or shorter time than usual, eating or drinking less than normal)
Drowsiness
Pain in the areas of infection
What tests might be needed?
Usually, your child will need to be admitted under the care of the dermatology team or a Burns Unit and have at least a few days in hospital until their skin condition improves.
Your child’s doctor will take a skin swab to check if the bacteria that causes this condition is growing on the skin. Blood tests may also be required to see if the bacteria has passed from the skin into the blood. Occasionally, a small sample of skin may be taken to look at under the microscope, as it can help rule out other serious skin conditions that may look similar.
What treatments are available?
What can i do?
Keep your child comfortable and offer regular pain relief
Follow advice regarding dressing when discharged home
Medical Therapies
Because this condition is caused by a bacterium, antibiotics are required. These antibiotics are high strength, and so are usually given through a drip. Your child will need to stay in hospital till the antibiotics are finished.
Other treatments may also be given to support your child’s recovery. This includes:
Fluids such as water, either through a drip or the mouth
Paracetamol for pain relief and control of fevers
Creams to keep the skin hydrated
Special dressings are ususally used to help manage the skin pain and also heal the skin - these are usually administered in specialised burns unit with nurses who manage burns.
What happens after treatment?
With appropriate treatment (as above), most children fully recover after one week. Sometimes if there is a delay in treatment, or if the treatment is not working, the infection can spread to other organs such as the blood or lungs. This may require more treatment, or a longer hospital stay.
Your GP will usually follow up with your child for ongoing review and care after discharge from hospital.
What support is available?
Your child's GP or dermatologist will be able to support you and your family throughout your child's illness and provide any ongoing support.
Authors/Reviewers:
Author: Dr Akshay Flora
Paediatric Reviewer: Dr Mayuri Sivagnanam
Photographs courtesy of Dr Deshan Sebaratnam
Editor in Chief: Dr Tevi Wain