Or your child may be treated in the intensive care unit (ICU). They cause skin damage by releasing epidermolytic toxins. In young infants, and in those with renal impairment, these can accumulate and result in widespread exfoliation of the skin known as Staphylococcal scalded skin syndrome (SSSS). These exotoxins are proteases that cleave desmoglein-1, which normally holds the granulosum and spinosum layers together, similar to the pathophysiology of the autoimmune skin disease, pemphigus vulgaris. J Eur Acad Dermatol Venereol. Staphylococcal Scalded Skin Syndrome is a pathological condition usually found in children and immune compromised individuals caused due to bacteria Staphylococcus aureus. J Infect Dis. 1 1. Treatment usually requires a hospital stay, often in the burn or intensive care unit of the hospital. Know the reason for the visit and what you want to happen. These blisters can occur at areas of the skin away from the initial site. This is sometimes confirmed by isolation of S. aureus from blood, mucous membranes, or skin biopsy; however, these are often negative. 2014; 28 (11): p.1418-23. The diagnosis of staphylococcal scalded skin syndrome (SSSS) can be made with confidence in the setting of a compatible clinical appearance with supporting histopathology, and established underlying Staphylococcal infection. Also write down any new instructions your provider gives you for your child. The prognosis in adults is generally much worse, and depends upon various factors such as time to treatment, host immunity, and comorbidities. Staphylococcal scalded skin syndrome is caused predominantly by phage group 2 staphylococci, particularly strains 71 and 55, which are present at localized sites of infection. Epidemiology of staphylococcal scalded skin syndrome in Germany. 10.1B) is an uncommon disorder affecting primarily infants and young children. Perioral crusting and fissuring are seen early in the course. (See also Overview of Bacterial Skin Infections.) Staphylococcal Scalded Skin Syndrome (SSSS) Lucy Liu 0 % Topic. Your child may also have tests, such as: Your child will likely need to be treated in the hospital. The staphylococcal scalded skin syndrome is a rare dermatological entity that in early stages may be confused with a flare-up of a rush of atopic … 0. However, it does predispose an individual to infection, espec… Certain strains of Staphylococcus aureus produce exfoliative toxins. The healthcare provider will ask about your child’s symptoms and medical history. These are serine proteases which are spread by the circulation from a localised source, causing widespread epidermal damage at distant sites. Treatment may include: Children who are treated right away usually recover with no scarring or other problems. Staphylococcal scalded skin syndrome (SSSS) is caused by toxigenic strains of Staphylococcus aureus, a gram-positive, catalase-positive bacterium. Staphylococcal scalded skin syndrome (SSSS) is a serious skin infection. Staphylococcal scalded skin syndrome (SSSS) is a serious skin infection caused by the bacterium Staphylococcus aureus. Staphylococcus is a type of bacterium of which there are more than 30 different varieties. It is caused by the release of exotoxins A and B from Staphylococcus aureus. 0. A growing number of otherwise healthy people are developing life-threatening staph infections. This is followed by redness of the skin. Koch's postulates have been fulfilled in that: (i) Staphylococcus aureus is isolated from every case; (ii) S. aureus can reprod … N/A. This produces a toxin that damages the outer layer of the skin causing it blister and to peel. They can include: The symptoms of staphylococcal scalded skin syndrome can be like other health conditions. The toxins bind to a molecule within the desmosome called Desm… Desmosomes are the part of the skin cell responsible for adhering to the adjacent skin cell. Staphylococcal scalded skin syndrome (SSSS) is a serious skin infection. Only 5% of all S aureus strains produce the epidermolytic toxins responsible for SSSS. This condition generally affects children < 5 years of age, and can be a severe and potentially life threatening illness, particularly in neonates 43.7). Staphylococcal scalded skin syndrome is the serious life-threatening disease which response to a toxin produced by a Staphylococcal aureus infection. The infection causes peeling skin over large parts of the body. Arbuthnott JP, Kent J, Lyell A, Gemmell CG. They break the epidermal cell adhesion molecule, desmoglein 1, breaking up the skin by preventing skin cells sticking to each other. The disease mostly affects infants, young children, and individuals with a depressed immune system or renal insufficiency. The mainstay of treatment for SSSS is supportive care along with eradication of the primary infection. The disease occurs predominantly in children under 5 years of age. SSSS is caused by the exfoliative toxins (epidermolytic toxins A and B) of some strains of Staphylococcus aureus. Clindamycin is sometimes also used because of its inhibition of exotoxins. The infection causes peeling skin over large parts of the body. Staphylococcal scalded skin syndrome is a response to a toxin produced by a staphylococcal infection and is characterized by peeling skin. Treatment usually involves antibiotics and drain… Other risk factors include: Symptoms can occur a bit differently in each child. The bacteria release poison (toxins) that cause the skin to blister and peel. 1972 Feb; 125 (2):129–140. Staphylococcal Scalded Skin Syndrome. SSSS is a clinical diagnosis. Staphylococcal scalded skin syndrome (SSSS) is a dermatological condition caused by Staphylococcus aureus. It rarely occurs in older people except for those with kidney failure or a weakened immune system. Usually, this bacterium resides on the skin and mucous membranes of humans but does no harm. General Information | Self-Checker | Donate and Lend Support | Staff Appreciation | Get Email Alerts. | Open in Read by QxMD; Yamasaki O, Yamaguchi T, Sugai M. Clinical Manifestations of Staphylococcal Scalded-Skin Syndrome Depend on Serotypes of Exfoliative Toxins. The disease can be life-threatening and needs treatment. This bacterium produces an … Know what to expect if your child does not take the medicine or have the test or procedure. The specific toxigenic strains usually belong to phage group 2 (types 3A, 3B, 3C, 55, or 71). Staphylococcal scalded skin syndrome: diagnosis and management in children and adults.. J Eur Acad Dermatol Venereol. The affected skin initially looks red, Review Topic. Although Dukes identified it as a separate entity, it is thought not to be different from scarlet fever caused by staphylococcal exotoxin after Keith Powell proposed equating it with the condition currently known as staphylococcal scalded skin syndrome in 1979. Staphylococcal scalded skin syndrome (SSSS) is an illness characterised by red blistering skin that looks like a burn or scald, hence its name staphylococcal scalded skin syndrome. The bacteria produce a toxin that causes the skin damage. For the past few days he has been refusing to eat and had minimal urinary output. Like other staphylococcal infections, staphylococcal scalded skin syndrome is contagious. We continue to provide in-person care and telemedicine appointments. Most strains of S. aureus implicated in SSSS have penicillinases, so are penicillin resistant. To guide PCH ED staff with the assessment and management of staphylococcal scalded skin syndrome in children. This is because the treatment is similar to treating a child with burns. This is important if your child becomes ill and you have questions or need advice. Know how you can contact your child’s provider after office hours. It is rare in adults, but when diagnosed, it often is associated with renal failure, immunodeficiency, or overwhelming staphylococcal infection. It looks like the skin has been scalded or burned by hot liquid. A unique case of a pregnant woman with chronic atopic dermatitis who developed SSSS is presented. What you should be alert for in the history. Staphylococcal scalded skin syndrome (SSSS), also known as Ritter von Ritterschein disease (in newborns), Ritter disease, and staphylococcal epidermal necrolysis, encompasses a spectrum of superficial blistering skin disorders caused by the exfoliative toxins of some strains of Staphylococcus aureus.. Scalded skin syndrome is caused by infection with certain strains of staphylococcus bacteria. Most of the time, these bacteria cause no problems or result in relatively minor skin infections. Staphylococcal scalded skin syndrome (SSSS) is a recognised clinical entity that affects primarily the very young and, in rare cases, the very old or the immunocompromised. 0. The staphylococcal scalded skin syndrome is an acute exfoliation of the skin caused by exfoliative toxins A and B. SSSS may be difficult to distinguish from toxic epidermal necrolysis and pustular psoriasis. It’s usually caused by an infection with a type of Staphylococcal aureas bacteria. Parenteral antibiotics to cover S. aureus should be administered. Most commonly it is caused by those belonging to phage group II (types 3A, 3B, 3C, 55, or 71) but occasionally to groups I and III. If there are changes in surgeries or other scheduled appointments, your provider will notify you. If the healthcare provider is not available, go to the emergency room. Also know what the side effects are. Date last published: 18 August 2020. It is a syndrome of acute exfoliation of the skin typically following an … Extensive areas of desquamation might be present. Ask if your child’s condition can be treated in other ways. Unlike toxic epidermal necrolysis, SSSS spares the mucous membranes. It is most common in children under 6 years, but can be seen in adults who are immunosuppressed or have kidney failure. The staphylococcal scalded-skin syndrome: isolation and partial characterization of the exfoliative toxin. Background. Toxic epidermal necrolysis produced by an extracellular product … It is characterized by the sudden onset of fever, skin tenderness, and erythema, followed by the formation of large, flaccid bullae and shedding of large sheets of skin, leaving a denuded, scalded-appearing surface. Staphylococcal scalded skin syndrome (Fig. The infection causes peeling skin over large parts of the body. But in some cases complications may include: Call the healthcare provider right away if your child has red, blistering skin. 0. Staphylococcal scalded skin syndrome (SSSS) is a serious skin infection. Ritter's disease of the newborn is the most severe form of SSSS, with similar signs and symptoms. Staph infections are caused by staphylococcus bacteria, types of germs commonly found on the skin or in the nose of even healthy individuals. [3], In 1885, Nil Filatow, and in 1894, Clement Dukes, described an exantematous disease which they thought to be a form of rubella, but in 1900, Dukes identified it to be a separate entity which came to be known by the names Dukes' disease,[4] Filatov’s disease, or fourth disease. It is necessary to treat scalded skin syndrome with intravenous antibiotics and to protect the skin from allowing dehydration to occur if large areas peel off. Staphylococcal scalded skin syndrome (SSSS) is a superficial blistering disorder mediated by Staphylococcus aureus exfoliative toxins. Staphylococcal scalded skin syndrome (SSSS) is a dermatological condition caused by Staphylococcus aureus. Staphylococcal scalded skin syndrome occurs almost exclusively in infants and children under the age of 6. He or she may be in the burn unit of the hospital. Staphylococcal Scalded Skin Syndrome Definition Staphylococcal scalded skin syndrome (SSSS) is a disease, caused by a type of bacteria, in which large sheets of skin may peel away. Know why a new medicine or treatment is prescribed and how it will help your child. Staphylococcal scalded skin syndrome: diagnosis and management in children and adults. Staphylococcal scalded skin syndrome is a reaction to a staphylococcal skin infection in which the skin blisters and peels off as though burned. It can occur at any age, but children under 5 years of age are at highest risk. Staphylococcal scalded skin syndrome is the severe condition caused by exfoliative staphylococcal toxins and is characterized by systemic signs and symptoms and generalized involvement of the skin (Fig. Questions. The damage creates blisters, as if the skin were scalded. N/A. Staphylococcus aureus is commonly found on human skin and begins colonization immediately after birth. It’s more common in the summer and fall. The prognosis of SSSS in children is excellent, with complete resolution within 10 days of treatment, and without significant scarring. Although Staphylococcus aureus is a common cause of burn wound infection, SSSS following burn wound infection is rare. Children who get prompt treatment usually recover with no scarring or complications. If your child has a follow-up appointment, write down the date, time, and purpose for that visit. SSSS often includes a widespread painful erythroderma, often involving the face, diaper, and other intertriginous areas. We continue to monitor COVID-19 in our area. It is known formally as Staphylococcal scalded skin syndrome and as Ritter disease. 2014 Nov;28(11):1418-23 Mockenhaupt M, Idzko M, Grosber M, Schopf E, Norgauer J. SSSS is caused by certain S. aureusstrains. SSSS is caused by the release of two exotoxins (epidermolytic toxins A and B) from toxigenic strains of the bacteria Staphylococcus aureus. This condition is characterized by blistering in the skin surface which more or less looks like a burn and that is what gives it the name of Staphylococcal Scalded Skin Syndrome. Treatment includes antibiotic medicine, replacing fluids, and skin care. It’s more common in the summer and fall. In children, the disease usually begins with fussiness (irritability), tiredness (malaise), and a fever. Staphylococcal scalded skin syndrome images, . Therefore, treatment with nafcillin, oxacillin, or vancomycin is typically indicated. The clinical features were first described in 1878 by Baron Gottfried Ritter von Rittershain, who observed 297 cases among children in a single Czechoslovakian children's home over a 10-year period. Skin biopsy may show separation of the superficial layer of the epidermis (intraepidermal separation), differentiating SSSS from TEN, wherein the separation occurs at the dermo-epidermal junction (subepidermal separation). It’s more common in the summer and fall. Before your visit, write down questions you want answered. Staphylococcal scalded skin syndrome (SSSS) is a condition of the skin that results from an infection caused by a strain of staphylococcal bacterium. Description SSSS primarily strikes children under the age of five, particularly infants. Method. Tips to help you get the most from a visit to your child’s healthcare provider: At Another Johns Hopkins Member Hospital: CHG Bathing to Prevent HealthcareAssociated Infections, General Pediatrics and Adolescent Medicine, Long-term (chronic) kidney disease or kidney failure, Fluid-filled blisters that break easily and leave an area of moist skin that soon becomes tender and painful, Large sheets of the top layer of skin may peel away, Your child’s age, overall health, and medical history, How well your child handles certain medicines, treatments, or therapies, If your child’s condition is expected to get worse, The opinion of the healthcare providers involved in your child's care, Antibiotic medicine given by IV (intravenous) line into the vein, Feedings through a tube from the mouth into the stomach (nasogastric feeding), if needed, Use of skin creams or ointments and bandages, Loss of fluid causing dehydration and shock like a burn patient, Staphylococcal scalded skin syndrome is usually from a bacterial infection. Staphylococcal scalded skin syndrome is a , blistering skin conditionpainful which may cover a wide area of skin, bacteria called caused by a Staphylococcus aureus. This disease leads to peeling of outer layer skin to blister or it looks like burned by hot liquid. Aim. He or she will give your child a physical exam. Authoritative facts from DermNet New Zealand. [5][6][7][8], List of conditions caused by problems with junctional proteins, "Staphylococcal scalded skin syndrome: the expanded clinical syndrome", Cutaneous group B streptococcal infection, Recurrent toxin-mediated perineal erythema, https://en.wikipedia.org/w/index.php?title=Staphylococcal_scalded_skin_syndrome&oldid=993133091, Creative Commons Attribution-ShareAlike License, An infant with Staphylococcal scalded skin syndrome, This page was last edited on 8 December 2020, at 23:49. Staphylococcus aureus is the most common form associated with disease. Caused by a toxin emitted by the bacterium, rather than actual bacterial components, this syndrome leads to broad regions of exfoliating skin and is mainly observed in immunocompromised patients, newborns, infants and young children. Foci of infection include the nasopharynx and, less commonly, the umbilicus, urinary tract, a superficial abrasion, conjunctivae, and blood. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. One of the exotoxins is encoded on the bacterial chromosome, while the other is encoded on a plasmid. Know why a test or procedure is recommended and what the results could mean. doi: 10.1111/jdv.12541 . The syndrome is induced by epidermolytic exotoxins (exfoliatin)[2] A and B, which are released by S. aureus and cause detachment within the epidermal layer, by breaking down the desmosomes. Staphylococcal scalded skin syndrome (SSSS) is an uncommon, superficial blistering skin condition, characterised by widespread erythema and exfoliation, mainly occuring in children under five years of age, although older children and adults can be affected. It looks like the skin has been scalded or burned by hot liquid. The condition is characterized by red, painful, sometimes blistered skin that separates in layers, appearing as if it has been burned. Staphylococcal scalded skin syndrome (SSSS) is a potentially lethal complication of a Staphylococcus aureus infection. Make sure your child sees his or her healthcare provider for a diagnosis. Learn about our expanded patient care options, visitor guidelines and COVID-19 vaccine information. But staph infections can turn deadly if the bacteria invade deeper into your body, entering your bloodstream, joints, bones, lungs or heart. I… The disease can be life-threatening. The disease presents with the widespread formation of fluid-filled blisters that are thin walled and easily ruptured, and the patient can be positive for Nikolsky's sign. It looks like the skin has been scalded or burned by hot liquid. Snapshot: A newborn boy is brought to the emergency room for the evaluation of fever, red skin, and irritability. It is more common in infants than adults. However, SSSS must be differentiated carefully from toxic epidermal necrolysis, which carries a poor prognosis. Staphylococcal scalded skin syndrome is caused by a Staphylococcus or Staph infection. Conservative measures include rehydration, antipyretics (e.g., ibuprofen or paracetamol), management of thermal burns, and stabilization. Also used because of its inhibition of exotoxins Get prompt treatment usually recover with no scarring or complications it is. Care and telemedicine appointments seen early in the burn unit of the exfoliative toxin infections, staphylococcal scalded skin (! 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