Staphylococcal scalded skin syndrome

Staphylococcal scalded skin syndrome (SSSS) is a disease caused by a type ofbacteria in which large sheets of skin may peel away. It usually affects children under 5 (especially infants). Epidemics can occur in newborn nurseries when staff in those nurseries accidentally pass the causative bacteria betweenpatients, but it also can strike others with weakened immune systems. This may include those with kidney disease, people undergoing cancer chemotherapy,organ transplant patients, and people with Acquired Immunodeficiency Syndrome(AIDS).

SSSS is caused by a type of bacteria called Staphylococcus aureus thatproduces a kind of chemical poison. While the bacteria itself doesn't spreadthroughout the body, it affects the skin by sending this toxin through the bloodstream.

SSSS begins with a small area of infection. In newborns, this may appear as acrusted area around the navel or the diaper area. In children between the ages of 1 and 6, 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, followed by a rash beginning 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 peels off in large sheets.

The danger of this illness lies in the fact that a different kind of bacteriamay invade the raw areas of the skin and cause a serious bloodstream infection. A lot of body fluid is lost as the skin peels away, and the layer underneath dries out; dehydration is a danger at this point.

SSSS is usually diagnosed from the typical progression of symptoms in a childof this age. A sample of skin (skin biopsy) should be examined under a microscope, which will reveal a characteristic appearance.

Treatment involves applying a variety of lotions and creams to the skin to soothe the sensitive areas, and protect against drying and further moisture loss.

Most patients recover within 10 to 14 days without scarring in most patients.However, death may occur if severe dehydration or blood poisoning complicates the illness. About 3% of children die of these complications; about 50% ofimmunocompromised adults die of these complications.

As always, good hygiene can prevent the bacteria. In the event of an outbreakin a newborn nursery, staff members should have nasal smears taken to identify an adult who may be unknowingly carrying the bacteria and passing it on tothe babies.

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