Scalded skin syndrome
Scalded skin syndrome is a disease of infants and young children (usually under 5 years of age) and whose classic symptom is damage to the skin with marked shedding (exfoliation). Scalded skin syndrome (SSS) is a potentially deadly widespread skin infection that typically affects babies, young children, and those with depressed immune systems. It is
caused by toxins that are secreted by the insidious Staphylococcus aureus bacteria.
SSS usually spreads from a primary infection such as conjunctivitis. Symptoms include fever, profound weakness, and bright red skin. The skin develops large blisters that slough off in sheets, leaving large areas of the body without skin at all. Even normal-looking skin falls away with the slightest pressure. The loss of skin is terribly serious because it exposes the area to widespread infection. It also upsets the body’s temperature controls and fluid-balance mechanisms.
Scalded skin syndrome is caused by infection with certain strains of a bacteria called staphylococcus. During the infection, the staphylococci produce a poison (exotoxin) that is responsible for the skin damage. Onset of the illness may be heralded by fever and skin tenderness. The effects of the toxin first produces reddening of the skin. Fluid collects beneath the skin loosening it. Subsequently, light rubbing of the skin may pull away large sheets of skin leaving a raw red base (a finding called the Nikolsky sign). These bare areas dry out and crust over.
SSS begins with a small area of infection. In newborn babies, this may appear as a crusted area around the umbilicus, or in the diaper area. In children between the ages of one and six, a small, red, crusty bump appears near the nose or ear. The child may have no energy, and may have a fever. The skin becomes sensitive and uncomfortable even before the rash is fully visible. The rash starts out as bright red patches around the original area of crusting. Blisters may appear, and the skin may look wrinkled. When the blisters pop, they leave pitted areas. Even gently touching these red patches of skin may cause them to peel away in jagged sheets. The skin below is shiny, moist, and bright pink. Within a day or two, the top layer of skin all over the body is peeling off in large sheets.
The dangers of this illness include the chance that a different kind of bacteria will invade through the open areas in the skin and cause a serious systemic infection (sepsis). A lot of body fluid is lost as the skin peels away, and the layer underneath dries. Dehydration is a danger at this point.
Treatment involves careful attention to avoid the development of dehydration. A variety of lotions and creams are available to apply to areas where the epidermis has peeled away. This both soothes the sensitive areas, and protects against drying and further moisture loss. The prompt use of antibiotics is the medical treatment of choice. It is very important to take supplemental friendly bacteria both during and after antibiotic treatment in order to keep the friendly bacteria in strong numbers.
As always, good hygiene can prevent the passage of the causative bacteria between people. In the event of an outbreak in a newborn nursery, members of the staff should have nasal smears taken to identify an adult who may be unknowingly carrying the bacteria and passing it on to the babies.