Staphylococcal scalded skin syndrome: An epidemiological and clinical review of 84 cases

Abstract

Background: Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated, blistering skin disorder that mainly affects infants and children. There is limited literature regarding pediatric SSSS. The purpose of this study was to describe the epidemiology, clinical features, and management of pediatric SSSS. Methods: Retrospective cohort study of pediatric patients with a clinical diagnosis of SSSS seen at the Hospital for Sick Children in Toronto, Ontario, Canada, from January 1994 to March 2016. Results: We included 84 patients with a clinical diagnosis of SSSS; 49/84 (58%) were male. Mean age of diagnosis was 3.1 ± 2.4 years. All patients presented with erythema and exfoliation, while 64/84 (76%) presented with vesicles/ bullae. Skin tenderness was the most common symptom, present in 68/84 (81%) subjects. Staphylococcus aureus was more commonly isolated from periorificial cultures than from bullae. Mean hospitalization was 4.7 ± 2.3 days. No difference was found in admission duration between children receiving clindamycin and those that did not (3.6 ± 2.2 vs 3.9 ± 2.34 days, P = .63). Skin debridement was the only risk factor leading to more complications and prolonged hospitalization (P = .03). Severe complications were seen in 4 (5%) cases, and no fatalities were observed. Conclusions: Healthcare providers should be aware of SSSS and consider it in the differential diagnosis of infants and children with new onset erythema, exfoliation, and/ or vesiculation. Suspected culprit pathogens were more often obtained from periorificial swabs; however, these isolates were not tested for exfoliative toxin to confirm causality. Antibiotic treatment should be guided by sensitivity testing. Addition of clindamycin as an anti-toxin agent had no effect on the duration of hospitalization, and this should be further investigated. Surgical debridement of the skin in patients with SSSS should be discouraged.

Staphylococcal Scalded Skin Syndrome and Bullous Impetigo

“…SSSS usually begins in children with a prodrome of irritability, generalized fatigue, and fever [1]. The most common sites of initial localized infection by S. aureus in children include the conjunctiva, nose, throat, diaper area, umbilical stump, and circumcision or other surgical wounds (Table 1) [2,4].…”

“…S. aureus can also be cultured from the site of primary infection, such as the umbilicus, nasopharynx, conjunctiva, or surgical wounds in both children and adults [5]. Nasopharyngeal and periorificial cultures (perianal, perioral, periocular, nasal) are most likely to be positive [1].…”

“…Staphylococcal scalded skin syndrome (SSSS), also known as Ritter disease, is a potentially life-threatening infection caused by certain strains of Staphylococcus aureus (S. aureus) that release exfoliative toxins. Clinically, it is characterized by denudation of the skin and presents as large superficial blisters [1]. The overall incidence of SSSS in the general population is estimated to be between 0.09 and 0.56 cases per one million people [2].…”

How to Deal with Skin Biopsy in an Infant with Blisters?

“…The disease affects mostly neonates and children under 5 years of age but can also affect adults. In neonates, omphalitis is often the origin of the infection [ 2 ].…”

50 Years Ago in T J P

“…Topical antibiotics are not recommended, and use of steroids is contraindicated. 1,2 Children with SSSS must be isolated to prevent further outbreaks and provided with optimum supportive therapy for best results and least complications.…”