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Staphylococcal Scalded Skin Syndrome

Staphylococcal Scalded Skin Syndrome is a topic covered in the 5-Minute Emergency Consult.

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  • Results from the actions of a soluble epidermolytic exotoxin produced by Staphylococcus aureus:
    • Produced at a distant site of infection or colonization
    • Disseminates hematogenously
    • Lyses desmosomes of granular cells in the superficial epidermis
    • Results in generalized intradermal exfoliation
  • Typically affects infants and children <6 yr of age:
    • Adults have specific staph antibodies allowing them to localize, metabolize, and excrete the staph toxins.
    • Infants and children are unable to metabolize and excrete toxin efficiently.
    • Immunocompromised adults and those with severe renal dysfunction are also susceptible
  • Presentation determined by age and extent of rash:
    • Classic staphylococcal scalded skin syndrome
    • Pemphigus neonatorum
    • Bullous impetigo
    • Generalized in the newborn: Ritter disease
  • Typically, coagulase-positive phage group II Staphylococcus:
    • Phage groups I and III also implicated


  • Colonization often without overt infection
  • Concurrent infection or break of skin barrier:
    • Nasopharynx
    • Urinary tract
    • Minor skin abrasions
    • Circumcision site
    • Conjunctivitis
    • Umbilicus/omphalitis
    • Impetigo
    • Endocarditis and septicemia
  • Often no focus identified

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Rosen, Peter, et al., editors. "Staphylococcal Scalded Skin Syndrome." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307173/all/Staphylococcal_Scalded_Skin_Syndrome.
Staphylococcal Scalded Skin Syndrome. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307173/all/Staphylococcal_Scalded_Skin_Syndrome. Accessed April 24, 2019.
Staphylococcal Scalded Skin Syndrome. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307173/all/Staphylococcal_Scalded_Skin_Syndrome
Staphylococcal Scalded Skin Syndrome [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307173/all/Staphylococcal_Scalded_Skin_Syndrome.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Staphylococcal Scalded Skin Syndrome ID - 307173 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307173/all/Staphylococcal_Scalded_Skin_Syndrome PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -