scalded skin syndrome

SSSS is caused by exfoliative toxins (epidermolysins A and B) produced by specific strains of Staphylococcus aureus. These toxins cleave desmoglein-1, a desmosomal protein in the superficial epidermis, causing loss of cell-to-cell adhesion in the granular layer. The condition typically begins with fever, irritability, and skin tenderness, followed by diffuse erythema starting around the mouth, neck, and flexural areas. Within 1-2 days, large, flaccid bullae develop and rupture easily, leaving behind moist, red areas. The skin separates in sheets with minimal pressure (positive Nikolsky sign). Unlike toxic epidermal necrolysis, SSSS involves only the superficial epidermis, so mucosal surfaces are typically spared. The infection source is often distant (conjunctivitis, otitis media, or umbilical infection in neonates). Treatment involves systemic antistaphylococcal antibiotics (cloxacillin, nafcillin, or vancomycin for MRSA). Prognosis is generally excellent in children with prompt treatment, but mortality can be higher in adults due to decreased toxin clearance.