Staphylococcal Scalded Skin Syndrome - A Case Report

presented by

Jayakar Thomas MD, PhD

Chennai, India

on March 10, 2005

Senior Consultant Dermatologist, Kanchi Kamakoti CHILDS Trust Hospital, Chennai
& Apollo Hospitals, Chennai

Abstract Reported here is a child with staphylococcal scalded skin syndrome. The pictures of the child's day to day progress are presented. Systemic antibiotics and supportive measures are all that are required once the correct diagnosis is made. Sudden onset and periorificial involvement sparing the mucosa favor the diagnosis.
L.J., 1-year-old girl
3 days

An acutely ill child with erosive skin lesions of 3 days duration.
No history of drug intake.

Physical Examination

The child was very ill with multiple moist scaly lesions over the periorificial areas.
There were no mucosal lesions.


Day 1


Day 3


Day 5

Laboratory Data




Diagnosis Staphylococcal Scalded Skin Syndrome
Reasons Presented

A series of pictures are shown from day 1 to day 5 The child was treated with parenteral antibiotics and supportive measures.


What is the experience of other members in such cases?
How often are these cases missed as drug reactions and treated incorrectly with steroids?



Comments from Faculty and Members

Patrick Condry MD, Rochester, NY, USA on Mar 10, 2005

This is rather limited extent for the diagnosis. I might have thought of it as a more extensive bullous impetigo!

Brian Maurer PA, Enfield, CT, USA on March 10, 2005

Three pictures are worth a thousand words! How nice to be able to make a clinical diagnosis on the basis of history and physical examination alone. (I assume that the lack of recent drug exposure led the presenter away from a consideration of Stevens-Johnson Syndrome.) Nice presentation.

Carlos Garcia MD, Oklahoma City, OK, USA on March 10, 2005

I must admit that I have missed this diagnosis. One in particular comes to mind, in which I thought the child had Zn deficiency (necrolytic migratory erythema). Good case, thanks.

Shahbaz Janjua MD, Lalamusa, Pakistan on Mar 10, 2005

An excellent case presentation showing dramatic recovery. A focus of infection that usually precedes the onset of staphylococcal scalded skin syndrome prompts the use of drugs including antibiotics which are in most cases blamed to be the cause of subsequent blistering eruption by parents. Some physicians may also get confused to see the abrupt blistering eruption and may be compelled to use even systemic steroids in severe cases. Eradication of the focus of infection is important in the management. Supportive measures also help relieve the symptoms.

Sunil Dogra MD, Dept. of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India on March 10, 2005

The clinical picture in this case is characteristic of SSSS. Dermatologists are mostly experienced in making correct diagnosis, however it may be missed by primary care physicians/pediatricians. We do sometime get children with SSSS referred to our centre as drug rash or zinc deficiency. Response to treatment with systemic antibiotics and supportive measures is promising in children.

Lawrence Eron MD, Honolulu, HI, USA on March 11, 2005

I hadn't realized that SSSS was circumoral in distribution. It looks a little like eczema herpeticum (except that this kiddo didn't have eczema). Thanks so much for the excellent photos.

David Elpern MD, Williamstown, MA, USA on Mar 17, 2005

This is a fine case with good teaching points. I've only see a couple of similar cases. I remember the first. This was in 1979 and I was a resident and was called to the pediatric emergency ward to see a very similar child. He looked toxic, had generalized erythema and the same peculiar exudative crusting around the mouth and nose. The clinical picture is distinctive and singular. The beauty is that in children, most do well with appropriate antibiotics. In adults, the prognosis is worse with a mortality rate of > 50%.
Hurwitz's Pediatric Dermatology has a good table on SSSS. Here are the points:
1) Generally in children < 5 yo
2) Caused by epidermolytic toxin usually group II staph
3) Clinical features
a) Fever, tender erythematous skin
b) exfoliation with crusting around mouth, eyes, parfanasal
c) Positive Nikolsky sign
4) Diagnosis by Tzanck or bacterial culture.

Khalifa Shaquie MD, PhD, Professor of Dermatology, College of Medicine, University of Baghdad, Baghdad, Iraq on Mar 17, 2005

I would like to make the following comments.
1-SSS could be localised with minimal symptoms.
2-The impetigo like lesion around the mouth is very good clue for diagnosis.The whole picture could be named impetigo contagiosa around orifices ?
3-Acrodermatitis enteropathica is chronic process with burn like lesions localised on typical areas which should not be confused with SSS

Abir Saraswat MD, Lucknow, India on Mar 28, 2005

Nice representative case. I cannot help but mention a similar child I am managing at present, who had classical periorificial and generalized SSSS superimposed on another bullous disorder-- Chronic bullous disease of childhood. The former subsided rapidly with Cloxacillin syrup, clearly leaving behind the deeper CBDC bullae. Made an excellent demonstration case for my undergrad students. I have the clinical photos which I can send to anyone who is interested.

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