Staphylococcal Scalded Skin Syndrome

  • Louise Malburg
  • Garrett S. PachecoEmail author


Staphylococcal scalded skin syndrome is a serious and potentially life-threatening infection that requires prompt recognition and intervention. This chapter will discuss the physiology behind this exotoxin-mediated disease that results in diffuse erythroderma and subsequent desquamation. Key clinical characteristics, such as the absence of mucosal membrane involvement, are reviewed to aid in early recognition of SSSS and differentiation from conditions with a similar appearance. Treatment with anti-staphylococcal antibiotics and dermatologic care measures is essential in the acute management of SSSS, in addition to prevention of secondary infection, which is a common cause of mortality.


Staphylococcal scalded skin syndrome Exotoxin Desmoglein 1 Flaccid bullae Nikolsky sign Intraepidermal cleavage Stratum granulosum Stratum corneum Desquamation Bullous impetigo Acantholysis Anti-staphylococcal antibiotics 


  1. 1.
    Pollack S. Staphylococcal scalded skin syndrome. Pediatr Rev. 1996;17(1):18. Scholar
  2. 2.
    Handler MZ, Schwartz RA. Staphylococcal scalded skin syndrome: diagnosis and management in children and adults. J Eur Acad Dermatol Venereol. 2014;28:1418–23. Scholar
  3. 3.
    Iwatsuki K, Yamasaki O, Morizane S, Oono T. Staphylococcal cutaneous infections: invasion, evasion and aggression. J Dermatol Sci. 2006;42(3):203–14. Scholar
  4. 4.
    Li MY, Hua Y, Wei GH, Qiu L. Staphylococcal scalded skin syndrome in neonates: an 8-year retrospective study in a single institution. Pediatr Dermatol. 2013;31(1):43–7. Scholar
  5. 5.
    Amagai M. Desmoglein as a target in autoimmunity and infection. J Am Acad Dermatol. 2003;48(2):244–52. Scholar
  6. 6.
    Amagai M, Matsuyoshi N, Wang ZH, Andl C, Stanley JR. Toxin in bullous impetigo and staphylococcal scalded-skin syndrome targets desmoglein 1. Nat Med. 2000;6(11):1275–7. Scholar
  7. 7.
    Makhoul IR, Kassis I, Hashman N, Sujov P. Staphylococcal scalded-skin syndrome in a very low birth weight premature infant. Pediatrics. 2001;108(1)
  8. 8.
    Bukowski M, Wladyka B, Dubin G. Exfoliative toxins of Staphylococcus aureus. Toxins. 2010;2(5):1148–65. Scholar
  9. 9.
    Mishra AK, Yadav P, Mishra AA. Systemic review on staphylococcal scalded skin syndrome (SSSS): a rare and critical disease of neonates. Open Microbiol J. 2016;10(1):150–9. Scholar
  10. 10.
    Marina SS, Bocheva GS, Kazanjieva JS. Severe bacterial infections of the skin: uncommon presentations. Clin Dermatol. 2005;23(6):621–9. Scholar
  11. 11.
    Patel G, Finlay A. Staphylococcal scalded skin syndrome: diagnosis and management. Am J Clin Dermatol [serial online]. 2003;4(3):165–75. Available from: Academic Search Complete, Ipswich, MA. Accessed 10 July 2017.CrossRefGoogle Scholar
  12. 12.
    Kouakou K, Dainguy ME, Kassi K. Staphylococcal scalded skin syndrome in neonate. Case Rep Dermatol Med. 2015;2015:1–4. Scholar
  13. 13.
    Arora P, Kalra VK, Rane S, McGrath EJ, Zegarra-Linares R, Chawla S. Staphylococcal scalded skin syndrome in a preterm newborn presenting within first 24 h of life. BMJ Case Rep. 2011;2011:bcr0820114733. Scholar
  14. 14.
    Conway DG, Lyon RF, Heiner JDA. Desquamating rash. Ann Emerg Med. 2013;61(1):118–29. Scholar
  15. 15.
    Hubiche T, Bes M, Roudiere L, Langlaude F, Etienne J, Giudice PD. Mild staphylococcal scalded skin syndrome: an underdiagnosed clinical disorder. Br J Dermatol. 2011;166(1):213–5. Scholar
  16. 16.
    Singh SN, Tahazzul M, Singh A, Chandra S. Varicella infection in a neonate with subsequent staphylococcal scalded skin syndrome and fatal shock. Case Rep. 2012;2012(jul31 1)
  17. 17.
    Lamand V, Dauwalder O, Tristan A, et al. Epidemiological data of staphylococcal scalded skin syndrome in France from 1997 to 2007 and microbiological characteristics of Staphylococcus aureus associated strains. Clin Microbiol Infect. 2012;18(12)
  18. 18.
    Thomas C, Yazdan P, Cotliar JA. Coexistence of staphylococcal scalded skin syndrome and acute graft-vs-host disease. JAMA Dermatol. 2015;151(3):343. Scholar
  19. 19.
    Farroha A, Frew Q, Jabir S, Dziewulski P. Staphylococcal scalded skin syndrome due to burn wound infection. Ann Burns Fire Disasters. 2012;25(3):140–2.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Koufakis T, Gabranis I, Karanikas K. Staphylococcal scalded skin syndrome in an adult, immunocompetent patient. Braz J Infect Dis. 2015;19(2):228–9. Scholar
  21. 21.
    Porzionato A, Aprile A. Staphylococcal scalded skin syndrome mimicking child abuse by burning. Forensic Sci Int. 2007;168(1)
  22. 22.
    Bae SH, Lee J-B, Kim S-J, Lee S-C, Won YH, Yun SJ. Case of bullous impetigo with enormous bulla developing into staphylococcal scalded skin syndrome. J Dermatol. 2015;43(4):459–60. Scholar
  23. 23.
    Ugburo A, Temiye E, Ilombu C. A 12-year retrospective study of non-burn skin loss (burn-like syndromes) at a tertiary burns unit in a developing country. Burns. 2008;34(5):637–43. Scholar
  24. 24.
    Dobson C, King C. Adult staphylococcal scalded skin syndrome: histological pitfalls and new diagnostic perspectives. Br J Dermatol. 2003;148(5):1068–9. Scholar
  25. 25.
    Elston DM, Stratman EJ, Miller SJ. Skin biopsy. J Am Acad Dermatol. 2016;74(1):1–16. Scholar
  26. 26.
    Stanley JR, Amagai M. Pemphigus, bullous impetigo, and the staphylococcal scalded-skin syndrome. N Engl J Med. 2006;355(17):1800–10. Scholar
  27. 27.
    Tseng H-C, W-M W, Lin S-H. Staphylococcal scalded skin syndrome in an immunocompetent adult, clinically mimicking toxic epidermal necrolysis. J Dermatol. 2014;41(9):853–4. Scholar
  28. 28.
    Sladden MJ, Mortimer NJ, Elston G, Newey M, Harman KE. Staphylococcal scalded skin syndrome as a complication of septic arthritis. Clin Exp Dermatol. 2007;32(6):754–5. Scholar
  29. 29.
    Ladhani S. Recent developments in staphylococcal scalded skin syndrome. Clin Microbiol Infect. 2001;7(6):301–7. Scholar
  30. 30.
    Blyth M, Estela C, Young AE. Severe staphylococcal scalded skin syndrome in children. Burns. 2008;34(1):98–103. Scholar
  31. 31.
    Gupta A, Jacobs N. Visual diagnosis. Pediatr Rev. 2013;34(3):9–12. Scholar
  32. 32.
    Braunstein I, Wanat KA, Abuabara K, Mcgowan KL, Yan AC, Treat JR. Antibiotic sensitivity and resistance patterns in pediatric staphylococcal scalded skin syndrome. Pediatr Dermatol. 2013;31(3):305–8. Scholar
  33. 33.
    Baartmans MGA. Neonate with staphylococcal scalded skin syndrome. Arch Dis Child Fetal Neonatal Ed. 2006;91(1)
  34. 34.
    Dudley M, Parsh B. Recognizing staphylococcal scalded skin syndrome. Nursing. 2016;46(12):68. Scholar
  35. 35.
    Kato T, Fujimoto N, Nakanishi G, et al. Adult staphylococcal scalded skin syndrome successfully treated with plasma exchange. Acta Dermato Venereologica. 2015;95(5):612–3. Scholar
  36. 36.
    Duijsters CE, Halbertsma FJ, Kornelisse RF, Arents NL, Andriessen P. Recurring staphylococcal scalded skin syndrome in a very low birth weight infant: a case report. J Med Case Reports. 2009;3:7313. Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of ArizonaTucsonUSA
  2. 2.Departments of Emergency Medicine & PediatricsUniversity of ArizonaTucsonUSA

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