Staphylococcal scalded skin syndrome (SSSS) is a serious skin infection caused by the bacterium Staphylococcus aureus. This bacterium produces an exfoliative toxin that causes the outer layers of skin to blister and peel, as if they’ve been doused with a hot liquid. SSSS — also called Ritter’s disease — is rare, affecting up to 56 people out of 100,000. It’s most common in children under 6.
The bacterium that causes SSSS is common in healthy people. According to the British Association of Dermatologists, 40 percent of adults carry it (usually on their skin or mucous membranes) with no ill effects.
Problems arise when the bacteria enter the body through a crack in the skin. The toxin the bacterium produces damages the ability of the skin to hold together. The upper layer of skin then breaks apart from the deeper layers, causing the hallmark peeling of SSSS.
The toxin can also enter the bloodstream, producing a reaction all over the skin. Because young children — especially newborns — have underdeveloped immune systems and kidneys (to flush the toxins out of the body), they’re most at risk. According to research published in the journal Annals of Internal Medicine, 98 percent of cases occur in children under 6. Adults with weakened immune systems or poor kidney function are also susceptible.
Early signs of SSSS usually begin with the hallmark symptoms of an infection:
- lack of appetite
- conjunctivitis (an inflammation or infection of the clear lining that covers the white portion of the eyeball)
You may also notice the appearance of a crusty sore. The sore typically appears in the diaper region or around the stump of the umbilical cord in newborns and on the face in children. In adults, it can appear anywhere.
As the toxin gets released, you may also notice:
- red, tender skin, either limited to the entry point of the bacteria or widespread
- easily broken blisters
- peeling skin, which can come off in large sheets
Diagnosis of SSSS is usually made via a clinical exam and a look at your medical history.
Because the symptoms of SSSS can resemble those for other skin disorders such as bullous impetigo and certain forms of eczema, your doctor may perform a skin biopsy or take a culture to make a more definitive diagnosis. They may also order blood tests and tissue samples taken by swabbing the inside the throat and nose.
In many cases, treatment will usually require hospitalization. Burn units are often best equipped to treat the condition.
Treatment generally consists of:
- oral or intravenous antibiotics to clear the infection
- pain medication
- creams to protect raw, exposed skin
Nonsteroidal anti-inflammatories and steroids aren’t used because they can have a negative effect on the kidneys and immune system.
As the blisters drain and ooze, dehydration can become a problem. You’ll be told to drink plenty of fluids. Healing typically begins 24–48 hours after treatment is started. Full recovery follows just five to seven days later.
Most people with SSSS recover with no problems or skin scarring if they receive prompt treatment.
However, the same bacterium that causes SSSS can also cause the following:
- cellulitis (an infection of the deep layers of the skin and the fat and tissues that lie below it)
- sepsis (infection of the bloodstream)
These conditions can be life-threatening, which makes prompt treatment all the more important.
SSSS is rare. It can be serious and painful, but it’s usually not deadly. Most people recover fully and quickly — without any lasting side effects or scarring — with prompt treatment. See your doctor or your child’s doctor as soon as possible if you see symptoms of SSSS.