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Staphylococcal scalded skin syndrome in Adult
Other Resources UpToDate PubMed

Staphylococcal scalded skin syndrome in Adult

Contributors: Lauren Ko, Susan Burgin MD
Other Resources UpToDate PubMed


Staphylococcal scalded skin syndrome (SSSS), or Ritter disease, is a toxin-mediated infection characterized by skin tenderness, flaccid bullae, and skin detachment. A prodrome of fever, sore throat, and malaise, accompanied by purulent rhinorrhea and/or conjunctivitis, often occurs prior to the onset of bullae and desquamation.

SSSS is mainly a disease of infants and children younger than 6, with a higher incidence seen in males. With appropriate antibiotics, SSSS often resolves entirely in 1-2 weeks. However, many adults who suffer from SSSS have underlying medical problems such as renal insufficiency, and mortality rates are estimated at 60% or higher in immunocompromised patients.

In the United States, phage group II staphylococci are the most common toxin-producing strains. These phage group II strains can be methicillin-sensitive and resistant and produce exotoxins (epidermolytic toxins A and B or ETA and ETB, respectively) that cause intraepidermal cleavage with subsequent superficial sloughing. Specifically, ETA and ETB are serine proteases that cleave the extracellular domain of desmoglein 1, a molecule that facilitates keratinocyte adhesion. Note that bullous impetigo and toxic shock syndrome are also toxin-mediated diseases considered within the same spectrum of SSSS.

The natural history of SSSS is characterized by the following:
  • Prodromal symptoms and/or purulent rhinorrhea and/or conjunctivitis
  • Facial erythema that generalizes to the body in less than 48 hours
  • Bullae development, positive Nikolsky's sign, and very tender skin
  • Skin wrinkling and epidermal sloughing within 48 hours after bullae develop
  • Desquamation continues for up to 5 days
  • Re-epithelialization without scarring in approximately 2 weeks


L00 – Staphylococcal scalded skin syndrome

200946001 – Staphylococcal scalded skin syndrome

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Last Reviewed:06/08/2017
Last Updated:06/14/2017
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Staphylococcal scalded skin syndrome in Adult
A medical illustration showing key findings of Staphylococcal scalded skin syndrome : Bullae, Desquamation, Erythroderma, Painful skin lesions, Rhinorrhea, Widespread distribution, Conjunctival injection
Clinical image of Staphylococcal scalded skin syndrome - imageId=2140314. Click to open in gallery.  caption: 'Diffuse bright red erythema with large areas of overlying peeling on the trunk and legs.'
Diffuse bright red erythema with large areas of overlying peeling on the trunk and legs.
Copyright © 2024 VisualDx®. All rights reserved.