Common Skin Infections

Staphylococcal Scalded Skin Syndrome (SSSS)

Staphylococcal scalded skin syndrome (SSSS) is the most common of the toxin mediated disorders but even so, is fortunately rare. It presents as an acute toxic illness in children and is exceptionally rare in adults. The skin becomes bright red with superficial blisters and shedding (like a scald).

Clinical Tip - often starting in flexures and body folds with peeling skin.

Systemic upset with fever is usual and unlike toxic epidermal necrolysis (which it can mimic) there is no mucosal involvement. Staph aureus produces a toxin which attacks the outer part of epidermis, causing the typical peeling.

Staphylococcal scalded skin syndrome – unwell child, with red, peeling skin, initially flexural involvement

Prognosis is very good if treated with antibiotics (flucloxacillin). Remember that only the outer epidermis is damaged. The inner epidermis is preserved which preserves most of skin function (unlike in Toxic epidermal necrolysis where one sees full thickness epidermal necrosis). Patients should be seen by a dermatologist as an emergency.

Toxic shock syndrome

This is best known for occurring in tampon users. It is luckily fairly rare but can be fatal. Fever and an initial faint macular erythema or scarlatiniform rash is typical in the beginning, with mucosal erythema a common sign. 1-3 weeks later circulatory shock and multi-system disease occurs. Treatment involves antibiotics and supportive care.

Clinical Tip: Shocked female patients -ask if they are menstruating and using tampons.