Scalded skin syndrome

Answer 1

Definition

Scalded skin syndrome is a skin infection in which the skin becomes damaged and sheds.

Alternative Names

Ritter disease; Staphylococcal scalded skin syndrome (SSS)

Causes, incidence, and risk factors

Scalded skin syndrome is caused by infection with certain strains of bacteria in the Staphylococcus family. During the infection, the staphylococci produce a poison that causes the skin damage. The damage creates blisters as if the skin were scalded.

Scalded skin syndrome is found most commonly in infants and children under the age of 5.

Symptoms

• Blisters
• Fever
• Large areas of skin peel or fall away (exfoliation or desquamation)
• Painful skin
• Redness of the skin (erythema), which spreads to cover most of the body
• Skin slips off with gentle pressure, leaving wet red areas (Nikolsky's sign)

Signs and tests

• Positive Nikolsky's sign (skin slipping off when rubbed)

Tests include:

• Complete blood count (CBC)
• Cultures of the skin and throat
• Electrolytetest
• Skin biopsy(done only in rare cases, such as when the skin condition may be due to a drug reaction known as toxic epidermal necrolysis or TEN)

Treatment

Intravenousantibiotics for staphylococcus are given to help fight the infection. Because much fluid is lost through the open skin, it's important to get intravenous fluid to prevent dehydration.

Moist compresses to the skin may improve comfort. You can apply an emollient to keep the skin moist. Healing begins about 10 days after treatment.

Expectations (prognosis)

The prognosis is usually excellent. A full recovery is expected.

Complications

• Fluid regulation problems causing dehydration or electrolyte imbalance
• Poor temperature control (in young infants)
• Severe bloodstream infection (septicemia)
• Spread to deeper skin infection (cellulitis)

Calling your health care provider

Call your health care provider or go to the emergency room if you have symptoms of this disorder.

Prevention

The disorder may not be preventable. Treating any staphylococcus infection quickly can help.

References

Korman NJ. Macular, papular, vesiculobullous, and pustular diseases. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 465.

Answer 2

Definition

Scalded skin syndrome is a skin infection in which the skin becomes damaged and sheds.

Alternative Names

Ritter disease; Staphylococcal scalded skin syndrome (SSS)

Causes, incidence, and risk factors

Scalded skin syndrome is caused by infection with certain strains of Staphylococcus bacteria. The bacteria produce a poison that causes the skin damage. The damage creates blisters as if the skin were scalded.

Scalded skin syndrome is found most commonly in infants and children under the age of 5.

Symptoms

• Blisters
• Fever
• Large areas of skin peel or fall away (exfoliation or desquamation)
• Painful skin
• Redness of the skin (erythema), which spreads to cover most of the body
• Skin slips off with gentle pressure, leaving wet red areas (Nikolsky's sign)

Signs and tests

The health care provider will perform a physical exam and look at the skin. The exam may show that the skin slips off when it is rubbed. This is called a positive Nikolsky's sign.

Tests may include:

• Complete blood count (CBC)
• Cultures of the skin and throat
• Electrolytetest
• Skin biopsy (in rare cases)

Treatment

Antibiotics are given through a vein (intravenously) to help fight the infection. Fluids are also given through a vein to prevent dehydration. Much of the body's fluid is lost through open skin.

Moist compresses to the skin may improve comfort. You can apply a moisturizing ointment to keep the skin moist. Healing begins about 10 days after treatment.

Expectations (prognosis)

A full recovery is expected.

Complications

• Fluid regulation problems causing dehydration or electrolyte imbalance
• Poor temperature control (in young infants)
• Severe bloodstream infection (septicemia)
• Spread to deeper skin infection (cellulitis)

Calling your health care provider

Call your health care provider or go to the emergency room if you have symptoms of this disorder.

Prevention

The disorder may not be preventable. Treating any staphylococcus infection quickly can help.

References

Morelli JG.Staphylococcal Scalded Skin Syndrome (Ritter Disease).In: Kliegman RM,Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics.19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 657.3.

Reviewed By

Review Date: 12/06/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.