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Staphylococcal-scalded skin syndrome: evaluation, diagnosis, and management

World Journal of Pediatrics volume 14, pages 116–120 (2018)Cite this article

Abstract

Background

Staphylococcal-scalded skin syndrome (SSSS), also known as Ritter disease, is a potentially life-threatening disorder and a pediatric emergency. Early diagnosis and treatment is imperative to reduce the morbidity and mortality of this condition. The purpose of this article is to familiarize physicians with the evaluation, diagnosis, and treatment of SSSS.

Data sources

A PubMed search was completed in Clinical Queries using the key terms “Staphylococcal scalded skin syndrome” and “Ritter disease”.

Results

SSSS is caused by toxigenic strains of Staphylococcus aureus. Hydrolysis of the amino-terminal extracellular domain of desmoglein 1 by staphylococcal exfoliative toxins results in disruption of keratinocytes adhesion and cleavage within the stratum granulosum which leads to bulla formation. The diagnosis is mainly clinical, based on the findings of tender erythroderma, bullae, and desquamation with a scalded appearance especially in friction zones, periorificial scabs/crusting, positive Nikolsky sign, and absence of mucosal involvement. Prompt empiric treatment with intravenous anti-staphylococcal antibiotic such as nafcillin, oxacillin, or flucloxacillin is essential until cultures are available to guide therapy. Clarithromycin or cefuroxime may be used should the patient have penicillin allergy. If the patient is not improving, critically ill, or in communities where the prevalence of methicillin-resistant S. aureus is high, vancomycin should be used.

Conclusion

A high index of suspicion is essential for an accurate diagnosis to be made and treatment promptly initiated.

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Affiliations

  1. Department of Pediatrics, The Alberta Children’s Hospital, The University of Calgary, Calgary, #200, 233-16th Avenue NW, Calgary, AB, T2M 0H5, Canada

    Alexander K. C. Leung

  2. Toronto Dermatology Centre, Toronto, ON, Canada

    Benjamin Barankin

  3. The Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia

    Kin Fon Leong

Authors
  1. Alexander K. C. Leung
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  2. Benjamin Barankin
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Contributions

AKCL wrote the first draft of the manuscript, as well as a statement of whether an honorarium, grant, or other form of payment was given to anyone to produce the manuscript. AKCL, BB, and KFL contributed to drafting and revising the manuscript. We have seen and approved the final version submitted for publication and take full responsibility for the manuscript.

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Correspondence to Alexander K. C. Leung.

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Leung, A.K.C., Barankin, B. & Leong, K.F. Staphylococcal-scalded skin syndrome: evaluation, diagnosis, and management. World J Pediatr 14, 116–120 (2018). https://doi.org/10.1007/s12519-018-0150-x

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Keywords

  • Blisters
  • Desquamation
  • Erythroderma
  • Exfoliative toxins
  • Staphylococcus aureus