Staphylococcal scalded skin syndrome in Child
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Synopsis
Staphylococcal scalded skin syndrome (SSSS), or Ritter disease, is an acute disease caused by epidermolytic toxins released by strains of Staphylococcus aureus. Any systemic or cutaneous infection with epidermolytic toxin producing S. aureus may induce SSSS. Oftentimes, it is a focal infection of the nasopharynx, conjunctivae, perineum, or umbilicus that produces toxins that lead to diffuse fragile bullae, which are often no longer intact at the time of presentation. Children younger than 6 are believed to have increased susceptibility to SSSS due to decreased renal ability to excrete the toxin. The severity ranges from limited cutaneous involvement to diffuse skin disease and sepsis.
Codes
ICD10CM:
L00 – Staphylococcal scalded skin syndrome
SNOMEDCT:
200946001 – Staphylococcal scalded skin syndrome
L00 – Staphylococcal scalded skin syndrome
SNOMEDCT:
200946001 – Staphylococcal scalded skin syndrome
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Bullous impetigo – Localized with honey-colored crusted plaques, bacteria present in bullae.
- Toxic shock syndrome – High fevers and severe systemic symptoms including vomiting and diarrhea; hypotension quickly ensues; diffuse scarlatiniform exanthem that starts on the trunk (in contrast to face in SSSS).
- Sunburn
- Kawasaki disease – Fever lasting more than 5 days with oral mucosal changes, conjunctival injection, and cervical lymphadenopathy.
- Drug hypersensitivity syndrome (DRESS)
- Exanthematous drug eruption
- Drug-induced erythroderma
- Toxic epidermal necrolysis (TEN) – Drug induced, high fevers, skin tenderness, mucosal erosions, and skin detachment about 1-3 weeks after the inciting medication is started.
- Stevens-Johnson syndrome – Drug induced, high fevers, skin tenderness, mucosal erosions, and skin detachment about 1-3 weeks after the inciting medication is started.
- Scarlet fever – 1 mm erythematous papules, always elevated WBC with left shift, eosinophilia in up to 20% of patients.
- Erythrodermic psoriasis
- Atopic dermatitis
- Contact dermatitis
- Ichthyosis
- Lupus erythematosus
- Pemphigus erythematosus
- Pityriasis rubra pilaris
- Scabies
- Seborrheic dermatitis
- Lymphomas
- Urticaria
- Erysipelas
- Necrotizing fasciitis – Rapidly progressing necrosis of fascia and subcutaneous fat.
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Therapy
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References
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Last Reviewed:06/08/2017
Last Updated:01/10/2018
Last Updated:01/10/2018
Staphylococcal scalded skin syndrome in Child