Staphylococcal scalded skin syndrome (SSSS) occurs as a result of some Staphylococcus (staph) infections. It produces discolored and blistered patches of skin that slough off. These patches can resemble a burn.

Staphylococcal scalded skin syndrome (SSSS), also known as Ritter’s disease, often begins with fever and flushing of the skin, which advances to the formation of easily ruptured blisters. The top layer of skin may start to peel, leaving behind discolored, moist skin.

SSSS is most common in infants and children, but it can affect adults who have advanced renal disease or a compromised immune system.

This article explores SSSS in more detail, including the causes, symptoms, diagnosis, and possible complications. It also looks at how to prevent and treat the condition.

SSSS develops as the result of a toxin that the staphylococcal bacteria produce. It causes fever and flu-like symptoms, along with flushing of the skin and the development of blisters. The top layer of skin will peel or rub off to reveal discolored, wet skin.

The application of gentle pressure to the skin will cause the top layer to rub off. This is called Nikolsky’s sign.

In newborns, SSSS may develop around the umbilical cord or in the diaper area. Older children and adults generally develop lesions on the torso, arms, legs, or face.

Many people carry staph bacteria on the skin or in the nose. It is generally harmless but can cause infection when it enters the body through a wound. There are more than 30 types of staph bacteria. The type most commonly associated with disease is Staphylococcus aureus.

SSSS occurs when staphylococcal bacteria produce toxins that enter the bloodstream and travel to the skin. The toxins interrupt a molecule called desmoglein 1, which is vital for cells in the epidermis to adhere to one another.

The top layer of skin, called the epidermis, cannot maintain its form with damaged desmoglein 1. It will slough off, revealing discolored, moist skin underneath.

Blisters filled with pus or thin, clear, or yellow fluid may develop at the site where the staph infection entered the body. If the infection remains localized to one site, doctors call this bullous impetigo. When it travels through the bloodstream to other areas of the body, a person has SSSS.

SSSS produces some systemic symptoms that may resemble those of other illnesses. These include:

  • fatigue
  • fever
  • discolored skin
  • irritability
  • blisters
  • weakness

Fluid-filled blisters may develop that rupture easily. The top layer of skin will slough off and leave moist skin beneath.

Lesions from SSSS may occur around the umbilical cord site or in the diaper area on newborns. In older children and adults, they more commonly occur on the torso, arms, legs, and face.

A doctor may perform a skin biopsy or a culture-of-lesion test to identify the presence of S. aureus bacteria. They may also order other blood tests.

The doctor may also rub the skin gently to check for Nikolsky’s sign.

Administering oral or IV antibiotics can address the underlying staph infection.

Healthcare professionals may cover the lesions with sterile gauze or dressings to minimize pain, limit further damage, and prevent infection. Ointments or creams can treat open wounds.

Commonly used antibiotics include:

  • cefazolin
  • nafcillin
  • oxacillin

Some people with SSSS may require IV fluids to prevent dehydration. If the areas of peeled skin are large or the staph infection is not responding to antibiotics, hospitalization may be necessary.

Some severe cases of SSSS require treatment in a burn unit.

After treatment, people commonly begin feeling better in a day or two. The skin will gradually heal over the next few days.

SSSS most commonly appears in newborns and children aged 6 years or younger. However, it can develop in adults who have kidney disease or a health condition that weakens their immune system.

Outbreaks of SSSS can occur when children are in close contact, such as at day care centers.

When SSSS affects large areas of the skin that then slough off, this can lead to problems regulating body temperature due to heat loss. Dehydration may also occur as moisture evaporates through exposed areas of the underlying skin.

Staph infections are contagious, and outbreaks of SSSS can occur in settings such as day care or treatment facilities. Isolating people with SSSS during treatment will protect others.

Severe cases of SSSS may require admission to a burn unit to treat open wounds.

SSSS has a mortality rate below 5% in children, with early diagnosis and treatment making a good outcome likely.

The prevention of SSSS begins with guarding against staph infections. People with the highest risk of staph infections include those:

  • with a weakened immune system or chronic illness
  • who have been in a healthcare facility for some time
  • with implanted medical devices, such as a pacemaker
  • receiving dialysis
  • with an open wound

People can help prevent staph infections from developing by:

  • cleaning wounds with soap and water before covering them with a sterile dressing
  • washing the hands with soap and water
  • using alcohol-based hand sanitizer
  • avoiding sharing personal items, such as razors and towels
  • washing the hands thoroughly after visiting a healthcare facility

SSSS, or Ritter’s disease, involves the discoloration and sloughing off of the top layer of skin as the result of a staph infection. The type of bacteria that causes SSSS is usually S. aureus.

Many people carry staph bacteria on the skin or in the mucous membranes of the nose. Newborns, children up to the age of 6 years, and those with a weakened immune system have the highest risk of developing SSSS.

SSSS in newborns often occurs around the umbilical cord area or in the diaper area. In older children and adults, it generally affects the trunk, arms, legs, or face.

The treatment typically includes antibiotics to fight the staph infection and topical care of the areas where the skin has rubbed off. In the most severe cases, admission to a burn unit may be necessary.

Most children feel better after a few days of antibiotic treatment, and the skin lesions usually heal on their own within several days.


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