Staphylococcal scalded skin syndrome (SSSS) results from a bacterial infection. It leads to discolored, blistered patches of skin that slough off. The affected areas may look burned.
Another name for SSSS is Ritter’s disease. The first symptoms may be a fever and flushing of the skin. A person may then develop patches of blisters that break easily. The top layer of skin may start to peel, leaving discolored, moist areas beneath.
SSSS is most common in infants and children, but it can develop in adults with chronic kidney disease or a weakened immune system.
This article explores SSSS in more detail, including the causes, diagnosis, treatments, and possible complications. It also looks at how to prevent the condition.
SSSS develops as the result of a toxin that bacteria in the Staphylococcus genus produce.
In someone with SSSS, the bacteria produce a toxin that splits apart the upper section of the epidermis, the skin’s top layer.
The toxins bind to and break up parts of skin cells that allow these cells to adhere to adjacent skin cells. As a result, cells from the epidermis detach from the next layer of skin.
In newborns, the characteristic skin changes may develop around the umbilical cord or in the diaper area. In older children and adults, they generally develop on the torso, arms, legs, or face.
Learn more about the structure and function of the skin here.
Many people carry Staphylococcus, or “staph,” bacteria on the skin or in the nose. These bacteria are generally harmless, but they can cause infection when they enter the body through a wound. There are more than 30 types of bacteria in this genus, and the type most commonly associated with disease is Staphylococcus aureus.
SSSS occurs when bacteria in this genus produce toxins that enter the bloodstream and travel to the skin. The toxins interrupt a molecule called desmoglein 1, which is vital for cells in the epidermis to adhere to one another.
The epidermis, the top layer of skin, cannot maintain its form with damaged desmoglein 1. It sloughs off, revealing discolored, moist skin beneath.
Blisters filled with pus or thin, clear or yellow fluid may develop at the site where the staph infection entered the body. If the infection remains in one area, doctors call it “bullous impetigo.” When it travels through the bloodstream to other areas, doctors diagnose SSSS.
This health condition causes some systemic symptoms that may resemble those of other illnesses. These include:
- flu-like symptoms, such as fatigue and a fever
- irritability
- blisters
- weakness
- a sore throat
- conjunctivitis
Then, skin tenderness and discoloration such as redness usually develop. The initial site of the infection may appear red and crusty.
In newborns, SSSS lesions may develop around the umbilical cord site or in the diaper area. In older children and adults, they more commonly form on the torso, arms, and face, and in areas where the skin creases, such as the groin, neck, and legs.
Fluid-filled blisters that rupture easily may also develop. Within 36–72 hours, widespread peeling or shedding of the skin may occur, leaving moist, reddish skin with shallow sores. These areas may resemble burned skin.
A doctor diagnoses this condition after checking for characteristic symptoms and doing a thorough evaluation that includes taking a detailed medical history.
The doctor may take a skin biopsy or do other tests to check for S. aureus bacteria. They may also order other blood tests.
The doctor may also rub the skin gently to check for Nikolsky’s sign, a blister that forms in response to the slight pressure.
A person can have oral antibiotics to treat the underlying staph infection. They may also receive treatment via IV injection so that medication goes directly into the bloodstream.
In addition, healthcare professionals may cover the lesions with sterile gauze or dressings to minimize any pain, limit further damage, and prevent further infection. Ointments and creams can treat open wounds.
- cefazolin
- nafcillin
- oxacillin
Some people with SSSS may also need IV fluids to prevent dehydration.
If the areas of peeled skin are large or the staph infection is not responding to antibiotics, hospitalization may be necessary. Some severe cases of SSSS require treatment in a burn unit.
After treatment begins, people usually start feeling better in a day or two. The skin will gradually heal over the next few days.
At-home management
When caring for a person with SSSS at home, be sure to:
- Wash hands before, during, and after contact with the person.
- Keep the skin clean and covered.
- Encourage them to eat and drink plenty of fluids.
- Administer all medications on time.
SSSS
Outbreaks of SSSS can occur anywhere that children are in close contact, such as at day care centers.
How do children get it?
In children, the bacteria may enter the body through a minor break in the skin, such as a cut, the umbilical stump, or diaper rash that breaks the skin. Older children may develop SSSS on their faces.
In anyone, the toxin can travel through the bloodstream to reach other areas.
Risk factors
Newborns are particularly susceptible because they do not have the antibodies to fight off the infection, and their kidneys cannot help clear the infection from the body.
SSSS is rare in adults because most have these antibodies, but adults with weakened immune systems may be at risk. This includes adults:
- with HIV, including those with AIDS
- undergoing chemotherapy
- taking medications that suppress the immune system
- with poor kidney function
- with chronic kidney disease
When SSSS affects large areas, the loss of skin can lead to difficulty regulating body temperature. Dehydration may also occur, as moisture evaporates through exposed areas.
Staph infections are contagious, and outbreaks of SSSS can occur in settings such as day care centers and treatment facilities. Isolating anyone with SSSS can protect others.
Severe cases may need treating in a burn unit.
In children, SSSS has a mortality rate of
Preventing SSSS begins with guarding against staph infections. People with the highest risk of staph infections include those:
- with a weakened immune system or chronic illness
- who have been in a healthcare facility for some time
- who have implanted medical devices, such as a pacemaker
- who receive dialysis
- who have one or more open wounds
People can help prevent staph infections by:
- cleaning wounds with soap and water, then covering them with sterile dressings
- washing the hands with soap and water
- using alcohol-based hand sanitizer
- not sharing personal items, such as razors and towels
- washing the hands thoroughly after visiting any healthcare facility
SSSS, or Ritter’s disease, involves the discoloration and sloughing off of the top layer of skin. It stems from a staph infection, and the bacteria that causes SSSS is usually S. aureus.
Newborns, children aged 6 years or younger, and anyone with a weakened immune system has a higher risk of developing SSSS. The skin changes in newborns may develop around the umbilical cord or diaper areas. In older children and adults, they may develop on the trunk, arms, legs, or face.
Doctors typically prescribe or administer antibiotics to fight the infection. They also care for affected areas of skin. When SSSS is severe, admission to a burn unit may be necessary.
A person may feel better after a few days of antibiotic treatment, and the skin lesions usually heal within several days.