Staphylococcal Scalded Skin Syndrome (SSSS)

Figure 4.7 A: Impetigo (Courtesy of Dr. Paul Getz) B: Bullous impetigo, arm C: SSSS (Reprint from Allen HB. Dermatology Terminology. New York, NY: Springer; 2010)

(Figure 4.7C)

• Exfoliative disease mainly in neonates and young children; can occur in adults with renal insufficiency or if immunocompromised (mortality > 50%)
• Presents with fever, conjunctivitis, initial tenderness of skin and erythema over body folds → generalized wrinkled appearance with subsequent exfoliation (“sad man” facies), perioral crusting/fissuring, + Nikolsky sign
• S. aureus phage II (types 3A, 3C, 55, or 71) present at a distant site (extralesional): ET (A/B) - binds desmoglein 1 in granular layer causing superficial bulla
• Culture of bullae - negative (infection at remote site)
• Treatment: penicillinase-resistant penicillin (i.e., dicloxacillin) and IV fluid support