Staphylococcal Scalded Skin Syndrome (SSSS) in Children

What is staphylococcal scalded skin syndrome in children?

Staphylococcal scalded skin syndrome (SSSS) is a serious skin infection. The infection causes peeling skin over large parts of the body. It looks like the skin has been scalded or burned by hot liquid. It’s more common in the summer and fall.

What causes SSSS in a child?

It’s caused by an infection with a type of Staphylococcal aureus bacteria. The bacteria releases poison (toxins) that cause the skin to blister and peel.

Which children are at risk for SSSS?

It can occur at any age, but children younger than age 6 are at highest risk. Other risk factors include:                                                                 

• Weak immune system
• Long-term (chronic) kidney disease or kidney failure

What are the symptoms of SSSS in a child?

Symptoms can occur a bit differently in each child. They can include:

• Fussiness (irritability)
• Tiredness
• Fever
• Redness of the skin
• Fluid-filled blisters that break easily and leave an area of moist skin that soon becomes tender and painful
• Large sheets of the top layer of skin that peel away

The symptoms of SSSS can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

How is SSSS diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and medical history and do a physical exam. Your child may also have tests, such as:

• Skin biopsy. A tiny sample of skin is sent to a lab and examined under a microscope. A frozen section can be done quickly to confirm the diagnosis.
• Cultures. These are tests to find out which bacteria are present. Cultures may be done of the blood, urine, nose and throat, and skin. In newborns, a culture of the belly button may also be done.

How is SSSS treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Your child will likely need to be treated in the intensive care (ICU)s or burn unit of the hospital. This is because the treatment is similar to treating a child with burns. Treatment may include:

• Antibiotic medicine given by IV (intravenous) line into the vein
• IV fluids to prevent dehydration
• Feedings through a tube from the mouth into the stomach (nasogastric feeding), if needed
• Use of skin creams or ointments and bandages
• Pain medicines

What are possible complications of SSSS in a child?

Children who are treated right away usually recover with no scarring or other problems. But in some cases, complications may include:

• Loss of fluid, causing dehydration and shock like a burn patient
• Infection that gets worse
• Scarring
• Death

When should I call my child's healthcare provider?

Call the healthcare provider right away if your child has red, blistering skin. If the healthcare provider is not available, go to the emergency room.

Key points about SSSS in children

• Staphylococcal scalded skin syndrome is a bacterial infection.
• In children, the disease usually starts with fussiness, tiredness, and a fever. This is followed by redness and blistering of the skin. 
• The disease can be life-threatening and needs treatment right away.
• Treatment usually requires a hospital stay, often in the burn or intensive care unit of the hospital.
• Treatment includes antibiotic medicine, fluid replacement, and skin care.
• Children who get treatment quickly usually recover with no scarring or complications.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s healthcare provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.