Scalded Skin Syndrome - Causes, Symptoms and Treatment

Staphylococcal scalded skin syndrome is an acute epidermolysis caused by a staphylococcal toxin. Scalded Skin Syndrome also is known as Ritter von Ritterschein disease in newborns, Ritter disease, Lyell disease, and staphylococcal epidermal necrolysis. Two exotoxins (ETs), epidermolytic toxin A (ET-A) and epidermolytic toxin B (ET-B), are responsible for the pathologic changes seen in Scalded Skin Syndrome. These toxins cause intraepidermal splitting through the granular layer by specific cleavage of desmoglein 1 (also the target protein in the autoimmune blistering dermatosis, pemphigus foliaceus), a desmosomal cadherin protein that mediates cell-to-cell adhesion of keratinocytes in the granular layer. Scalded skin syndrome is found most commonly in infants and very young children. Black children are less prone to SSS than white children. Scalded Skin Syndrome in adults is an exceedingly rare disorder. The effects of the toxin first produce reddening of the skin. Fluid collects beneath the skin, loosening it. Subsequently, light rubbing of the skin may pull away large sheets of skin leaving a raw, red base. These bare areas dry out and crust over. The most common symptoms of staphylococcal scalded skin syndrome. However, each child experiences symptoms differently. The disease usually begins with a fever and redness of the skin. Then, a fluid-filled blister may form. This blister ruptures very easily, leaving an area of moist skin. Other symptoms may include is crusted infection site, often around the nose or ears , red, painful areas around infection site, blistering ,fevers, chills, weakness and fluid loss.

Scalded Skin Syndrome usually spreads from a primary infection such as conjunctivitis. Scalded Skin Syndrome is usually associated with a trivial infective focus in the conjunctivae or the skin; however, severe infections, such as sepsis, do contribute to a low but appreciable fatality rate (4%). SSS begins with a small area of infection. In newborn babies, this may appear as a crusted area around the umbilicus, or in the diaper area. In children between the ages of one and six, a small, red, crusty bump appears near the nose or ear. The child may have no energy, and may have a fever. The skin becomes sensitive and uncomfortable even before the rash is fully visible. The rash starts out as bright red patches around the original area of crusting. Blisters may appear, and the skin may look wrinkled. Scalded Skin Syndrome develop low titers of immunoglobulin G antibodies specific for desmoglein-1 after binding and systemic digestion of desmoglein-1 by staphylococcal exfoliative toxins. Other genetic or environmental factors may be needed to extend the immune response to encompass pathogenic antibodies and to produce overt clinical pemphigus foliaceus. A lot of body fluid is lost as the skin peels away, and the layer underneath dries. Dehydration is a danger at this point. Intravenous antibiotics that are specific for staphylococcus are given to help fight the infection. Because much fluid is lost through the open skin, supplemental intravenous fluid is important to prevent dehydration. Good hygiene can prevent the passage of the causative bacteria between people.

Causes of Scalded Skin Syndrome

Common Causes and Risk factors of Scalded Skin Syndrome

• Staphylococcal exotoxin.
• Epidermolytic toxin A (ET-A).
• Epidermolytic toxin B (ET-B).
• Staphylococcus aureus (CA-MRSA)

Sign and Symptoms of Scalded Skin Syndrome

Common Sign and Symptoms of Scalded Skin Syndrome

• Crusted infection site, often around the nose or ears.
• Red, painful areas around infection site.
• Blistering.
• Fevers.
• Chills.
• Weakness.
• Fluid loss.
• Painful skin.

Treatment for Scalded Skin Syndrome

Common Treatment for Scalded Skin Syndrome

• Antibiotics are generally necessary to eradicate the staphylococcal infection. A penicillinase-resistant, anti-staphylococcal antibiotic such as flucloxacillin is used.
• Intravenous antibiotics that are specific for staphylococcus are given to help fight the infection. Because much fluid is lost through the open skin, supplemental intravenous fluid is important to prevent dehydration.
• Good hygiene can prevent the passage of the causative bacteria between people.
• Apply control measures, including strict enforcement of chlorhexidine hand washing, administration of an oral antibiotic therapy for workers who are infected, and application of mupirocin ointment for eradication of persistent nasal carriage.
• Moist compresses to the skin may improve comfort.