Summary about Disease
Staphylococcal Scalded Skin Syndrome (SSSS) is a severe skin infection, primarily affecting infants and young children, caused by toxins produced by certain strains of Staphylococcus aureus bacteria. These toxins cause the outer layer of skin (epidermis) to separate from the underlying layers, resulting in a scalded appearance.
Symptoms
Fever
Irritability
Diffuse, painful redness of the skin (usually starting around the mouth, nose, and groin)
Blisters that rupture easily, leaving raw, moist areas
Peeling of the skin in large sheets (desquamation), resembling scalded skin
Cracks or crusts around the mouth, nose, and eyes
Causes
SSSS is caused by exfoliative toxins (ETA and ETB) produced by certain strains of Staphylococcus aureus bacteria. These toxins act as serine proteases that target desmoglein 1, a protein crucial for cell-to-cell adhesion in the epidermis. The toxins are carried in the bloodstream from a localized infection (like impetigo or conjunctivitis) to the entire body, causing widespread skin damage.
Medicine Used
Antibiotics: Intravenous antibiotics are the mainstay of treatment, typically targeting Staphylococcus aureus*. Common antibiotics include cloxacillin, nafcillin, oxacillin, vancomycin or cephalosporins depending on local resistance patterns.
Pain Management: Pain relievers (analgesics) are used to manage discomfort associated with skin damage.
Topical emollients: Applied to maintain skin hydration and prevent secondary infections.
Is Communicable
The bacteria Staphylococcus aureus that causes SSSS is contagious. The disease itself (SSSS) is not directly contagious, but the bacteria can spread from person to person through direct contact or contact with contaminated objects. If someone is carrying the staph bacteria on their skin or in their nose, they can transmit it to others, who may then develop SSSS if infected by a toxin-producing strain and they have a limited immunity.
Precautions
Good Hygiene: Frequent handwashing with soap and water, especially after contact with infected individuals or contaminated surfaces.
Avoid Contact: Limit contact with individuals who have active Staphylococcus aureus infections (e.g., impetigo, boils).
Proper Wound Care: Clean and cover any cuts or scrapes to prevent Staphylococcus aureus from entering the body.
Isolation: If diagnosed with SSSS, the individual should be isolated to prevent the spread of the bacteria to others.
Disinfection: Thoroughly clean and disinfect surfaces that may be contaminated with Staphylococcus aureus.
Avoid Sharing: Do not share personal items like towels, clothing, and razors.
How long does an outbreak last?
With prompt and appropriate antibiotic treatment, the acute phase of SSSS typically lasts for 5-7 days. Skin peeling may continue for several days to weeks after the initial infection is controlled. Complete recovery, with skin returning to normal, usually occurs within 2-3 weeks.
How is it diagnosed?
Clinical Examination: Diagnosis is primarily based on the characteristic appearance of the skin lesions (redness, blisters, peeling).
Bacterial Culture: A sample from the nose, throat, blood or skin (if intact blister exist) can be cultured to identify Staphylococcus aureus.
Skin Biopsy: In some cases, a skin biopsy may be performed to confirm the diagnosis and rule out other conditions. Frozen section can assist in rapid diagnosis.
Timeline of Symptoms
Day 1-2: Fever, irritability, and localized redness of the skin, often around the mouth, nose, or groin.
Day 2-4: The redness spreads rapidly, and blisters begin to form. The skin becomes very tender to the touch.
Day 4-5: Blisters rupture easily, leaving raw, moist areas. The skin begins to peel off in large sheets (desquamation).
Day 5-7: Skin peeling continues. Antibiotics are administered.
Week 2-3: With appropriate treatment, the skin starts to heal, and new skin begins to grow.
Important Considerations
Early Diagnosis and Treatment: Prompt diagnosis and treatment with appropriate antibiotics are crucial to prevent serious complications such as sepsis, dehydration, and secondary infections.
Fluid and Electrolyte Balance: Maintain adequate hydration and electrolyte balance, as significant fluid loss can occur through the damaged skin.
Pain Management: Effective pain management is essential to keep the patient comfortable.
Secondary Infections: Monitor for signs of secondary bacterial or fungal infections, which can complicate the recovery process.
Careful Handling: Handle the affected skin gently to minimize pain and prevent further damage.
Barrier Nursing: Use reverse isolation during admission.
Differentiating from other conditions: SSSS needs to be differentiated from other similar condition like bullous impetigo, toxic epidermal necrolysis, drug reaction etc.