Staphylococcal scalded skin syndrome: An epidemiological and clinical review of 84 cases

Pediatr Dermatol. 2021 Jan;38(1):149-153. doi: 10.1111/pde.14470. Epub 2020 Dec 1.


Background: Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated, blistering skin disorder that mainly affects infants and children. There is limited literature regarding pediatric SSSS. The purpose of this study was to describe the epidemiology, clinical features, and management of pediatric SSSS.

Methods: Retrospective cohort study of pediatric patients with a clinical diagnosis of SSSS seen at the Hospital for Sick Children in Toronto, Ontario, Canada, from January 1994 to March 2016.

Results: We included 84 patients with a clinical diagnosis of SSSS; 49/84 (58%) were male. Mean age of diagnosis was 3.1 ± 2.4 years. All patients presented with erythema and exfoliation, while 64/84 (76%) presented with vesicles/ bullae. Skin tenderness was the most common symptom, present in 68/84 (81%) subjects. Staphylococcus aureus was more commonly isolated from periorificial cultures than from bullae. Mean hospitalization was 4.7 ± 2.3 days. No difference was found in admission duration between children receiving clindamycin and those that did not (3.6 ± 2.2 vs 3.9 ± 2.34 days, P = .63). Skin debridement was the only risk factor leading to more complications and prolonged hospitalization (P = .03). Severe complications were seen in 4 (5%) cases, and no fatalities were observed.

Conclusions: Healthcare providers should be aware of SSSS and consider it in the differential diagnosis of infants and children with new onset erythema, exfoliation, and/or vesiculation. Suspected culprit pathogens were more often obtained from periorificial swabs; however, these isolates were not tested for exfoliative toxin to confirm causality. Antibiotic treatment should be guided by sensitivity testing. Addition of clindamycin as an anti-toxin agent had no effect on the duration of hospitalization, and this should be further investigated. Surgical debridement of the skin in patients with SSSS should be discouraged.

Keywords: Staphylococcal scalded skin syndrome; antibiotics; pediatrics; skin infections.

Publication types

  • Review

MeSH terms

  • Canada
  • Child
  • Child, Preschool
  • Clindamycin
  • Female
  • Humans
  • Infant
  • Male
  • Retrospective Studies
  • Staphylococcal Scalded Skin Syndrome* / diagnosis
  • Staphylococcal Scalded Skin Syndrome* / drug therapy
  • Staphylococcal Scalded Skin Syndrome* / epidemiology
  • Staphylococcus aureus


  • Clindamycin