Staphylococcal scalded skin syndrome


  • Caused by Staph aureus
  • Bacteria release exotoxin which breaks down desmosomes
    • Exotoxin spread via bloodstream, therefore blisters not infected
  • Most patients <2yr old, nearly all <6 yr old

Clinical Features

Infant with Staphylococcal scalded skin syndrome
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  • Rash progresses from erythroderma (classically perioral) to extensive areas of exfoliation
  • Systemic symptoms (malaise, fever, irritability, skin tenderness) are common
  • Nikolsky sign (separation of epidermis when pressure is applied) is present
  • No mucous membrane involvement (differentiate from SJS/TENS)

Differential Diagnosis

Erythematous rash


  • PCR for toxin if available
  • CBC - leukocytosis, though normal WBC level oftenly
  • ESR elevation
  • Monitor electrolytes, renal function closely in severe disease
  • Blood cultures variably positive (more often pos in adults)
  • CXR to rule out pneumonia


Antibiotic Options


  • Transfer to burn center if diffuse
  • Localized infection may discharge home with follow up

See Also

External Links

Pediatric EM Morsels: Staph Scalded Skin Syndrome


  1. Randall WK et al. Staphylococcal Scalded Skin Syndrome Workup. eMedicine. Oct 28, 2015.
  2. Braunstein I, Wanat KA, Abuabara K, McGowan KL, Yan AC, Treat JR. Antibiotic sensitivity and resistance patterns in pediatric staphylococcal scalded skin syndrome. Pediatr Dermatol. 2014;31(3):305-308. doi:10.1111/pde.12195