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Staphylococcal Scalded Skin Syndrome (SSSS) in Children

What is staphylococcal scalded skin syndrome?

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?

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

Who is at risk for SSSS?

It can occur at any age, but children under 5 years of age 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?

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 may peel away

The symptoms of staphylococcal scalded skin syndrome can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is SSSS diagnosed?

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

  • Skin biopsy. A tiny sample of skin is taken and checked under a microscope. A frozen section can be done quickly to confirm the diagnosis.
  • Cultures. These are simple tests to check for bacteria. 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?

Your child's healthcare provider will figure out the best treatment plan for your child based on:
  • Your child’s age, overall health, and medical history
  • How severe your child’s condition is
  • How well your child handles certain medicines, treatments, or therapies
  • If your child’s condition is expected to get worse
  • The opinion of the healthcare providers involved in your child's care
  • Your opinion and preference

Your child will likely need to be treated in the hospital. He or she may be in the burn unit of the hospital. This is because the treatment is similar to treating a child with burns. Or your child may be treated in the intensive care unit (ICU). 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?

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 staphylococcal scalded skin syndrome

  • Staphylococcal scalded skin syndrome is usually from a bacterial infection.
  • In children, the disease usually begins with fussiness (irritability), tiredness (malaise), and a fever. This is followed by redness of the skin. 
  • The disease can be life-threatening and needs treatment.
  • Treatment usually requires a hospital stay, often in the burn or intensive care unit of the hospital.
  • Treatment includes antibiotic medicine, replacing fluids, and skin care.
  • Children who get prompt treatment 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 provider after office hours. This is important if your child becomes ill and you have questions or need advice.
Online Medical Reviewer: Berman, Kevin, MD, PhD
Online Medical Reviewer: Sather, Rita, RN
Last Review Date: 3/1/2017
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