Indian Pediatrics 2001; 38: 425  

Staphylococcal Scalded Skin Syndrome

This neonate presented with history of acute onset of a diffuse erythematous rash followed by bullae formation and peeling of skin over the entire body (Fig. 1). On examination, a focus of infection was localized to the umbilical stump. The patient received systemic antibiotic therapy including intravenous cloxacillin and netilmicin along with intravenous fluids. Marked improvement occurred in the week following admission with eventual full re-epithelialization.

Staphylococcal scalded skin syndrome (SSSS), also known as Ritter’s disease, is an exotoxin mediated disorder that is most commonly seen in children under 5 years of age. It is caused predominantly by phage group 2 staphylococcus and the range of illness varies from localized bullous impetigo to generalized cutaneous involvement with systemic illness. The clinical manifestions are mediated by hematogenous spread of exfoliative toxin A or B. The relatively impaired neonatal renal function places the newborn infant at high risk because of delayed clearance of the exotoxin.

The differential diagnosis of SSSS includes toxic epidermal necrolysis, streptococcal scarlet fever, Stevens-Johnson syndrome, Kawasaki’s disease, erythema multiforme and bullous impetigo. Histopathologically, the diagnosis of SSSS is characterized by superficial, noninflammatory separation of the epidermis occurring in the upper granular layer. The clinical diagnosis of SSSS, however, may be made by the appearance of superficial peeling with relative sparing of the mucus membranes.

Fig. 1. Neonate with SSSS showing generalized erythema and peeling of skin..

Sunil Narain, Pool Officer 
(Council of Scientific and Industrial Research),
Department of Pediatrics,
All India Institute of Medical Sciences,
New Delhi 110 029,
India.