Staphylococcal scalded skin syndrome


  • Caused by Staph aureus
  • 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 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


  1. Randall WK et al. Staphylococcal Scalded Skin Syndrome Workup. eMedicine. Oct 28, 2015.