Summary about Disease
Ritter's disease, also known as Staphylococcal Scalded Skin Syndrome (SSSS), is a severe skin infection primarily affecting infants and young children. It is characterized by widespread blistering and peeling of the skin, resembling a burn. It is caused by toxins produced by certain strains of Staphylococcus aureus bacteria.
Symptoms
Fever
Irritability
Widespread redness of the skin (erythema)
Blisters that easily rupture, causing the top layer of skin to peel off in sheets (Nikolsky's sign)
Painful skin
Dehydration
Causes
Ritter's disease is caused by toxins (exfoliatins) produced by certain strains of Staphylococcus aureus bacteria. These toxins disrupt cell adhesion in the outer layer of the skin (epidermis), leading to blistering and peeling. The bacteria often colonize the nose, throat, or umbilicus.
Medicine Used
Intravenous antibiotics (e.g., nafcillin, oxacillin, vancomycin - chosen based on local resistance patterns) to combat the Staphylococcal infection.
Pain medication to manage discomfort.
Intravenous fluids to prevent or treat dehydration.
Topical emollients and gentle wound care to protect the skin.
Is Communicable
The disease itself (the skin peeling) is not communicable. However, the Staphylococcus aureus bacteria that causes SSSS can be spread through direct contact or contact with contaminated objects. Therefore, isolating the patient and practicing good hygiene is important to prevent the spread of the bacteria to others.
Precautions
Strict handwashing by healthcare providers and caregivers.
Isolation of affected individuals to prevent spread of the bacteria.
Careful wound care to prevent secondary infections.
Avoidance of close contact with infected individuals.
Prompt treatment of any Staphylococcus aureus infections in family members or close contacts.
How long does an outbreak last?
With appropriate antibiotic treatment, the acute phase of Ritter's disease typically lasts for 2-5 days. The skin usually heals within 10-14 days without scarring, provided there are no complications.
How is it diagnosed?
Physical examination: Characteristic skin findings (widespread redness and blistering) are highly suggestive.
Bacterial culture: A culture from the nose, throat, blood or skin lesions can identify Staphylococcus aureus.
Skin biopsy: Rarely needed, but can confirm the diagnosis by showing characteristic epidermal separation.
Timeline of Symptoms
1. Initial Phase (1-2 days): Fever, irritability, and localized redness (erythema), often around the mouth, nose, and diaper area. 2. Erythema and Blistering (1-2 days): The redness spreads rapidly, and large, flaccid blisters develop. Nikolsky's sign is positive. 3. Desquamation (2-5 days): The blisters rupture easily, leading to widespread peeling of the skin in large sheets. 4. Recovery (10-14 days): With treatment, the skin heals gradually without scarring.
Important Considerations
Ritter's disease is more common and severe in infants and young children due to their immature immune systems and kidney function.
Early diagnosis and treatment with appropriate antibiotics are crucial to prevent complications such as dehydration, secondary infections (e.g., sepsis), and electrolyte imbalances.
Gentle skin care and pain management are important aspects of treatment.
Although rare, adults with compromised immune systems or kidney failure can also develop SSSS.
Recurrence is uncommon but possible.