Staphylococcal Scalded Skin Syndrome

Do not get burned by missing Staphylococcal scalded skin syndrome - Warren Heymann, MD

Staphylococcal Scalded Skin Syndrome
Staphylococcal Scalded Skin Syndrome

image by: Mobeen Syed

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Do not get burned by missing Staphylococcal scalded skin syndrome

I would be surprised if any first-year dermatology resident could not differentiate Staphylococcal scalded skin syndrome (SSSS) from toxic epidermal necrolysis (TEN). What is straightforward now was a source of confusion for decades. The following is an elegant summation by Mockenhaupt et al of how dermatology has arrived at the current understanding of SSSS:

“Staphylococcal scalded skin syndrome (SSSS) is a rare, systemic blistering skin disorder. The clinical features were first described in 1878 by Baron Gottfried Ritter von Rittershain, who observed 297 cases among children in a single Czechoslovakian foundling asylum in a 10-y period. Presumably in 1891 Staphylococcus aureus…

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 Do not get burned by missing Staphylococcal scalded skin syndrome

SSSS may present on a clinical spectrum and has been increasing in incidence. Although vastly more common in infants, adults with immunosuppression and renal impairment are at risk, with a much greater mortality. Changes in pathogenesis may be related to mupirocin resistance.


Infants are believed to have increased susceptibility to SSSS due to lack of neutralizing antibodies and decreased renal capacity for toxin excretion.


SSSS is differentiated from Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) based on the level of the epidermal separation and the fact that SSSS does not affect mucous membranes.

Staphylococcal scalded skin syndrome in a 4-year-old child: a case report

Staphylococcal scalded skin syndrome is an exfoliating skin disease which primarily affects children. Differential diagnosis includes toxic epidermal necrolysis, staphylococcal scalded skin syndrome, epidermolysis bullosa, and Stevens–Johnson syndrome. Staphylococcal scalded skin syndrome primarily affects children and can cause serious morbidity.


Staphylococcal Scalded Skin Syndrome, also known as Ritter disease is a disease characterized by denudation of the skin caused by exotoxin producing strains of the Staphylococcus species, typically from a distant site. It usually presents 48 hours after birth and is rare in children older than six years. It may also present in immunocompromised adults or those with severe renal disease.

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