Staphylococcal scalded skin syndrome is a severe skin condition caused by a staphylococcal infection. The infection is caused by the toxin exfoliatin (epidermolysin toxins A and B) produced by Group II coagulase-positive staphylococci (usually Staphylococcus aureus). These toxin bind to Desmoglein 1, part of the desomosome (the part of the skin responsible for adhesion to adjacent cells), causing the cells to become un-adhered. The condition is known as Ritter’s disease or Lyell’s disease when found in newborns or young infants.
Children younger than five years, and most commonly newborn babies, have the highest incidence of Staphylococcal scalded skin syndrome. During childhood, the body typically acquires immunity to staphylococcal exotins, reducing incidence in children and adults. Newborns typically lack specific immunity to toxins and coupled with immature renal clearance systems, newborns are at a higher risk for infection. Individuals who are immunocompromised or suffer from renal failure can develop Staphylococcal scalded skin syndrome at any age.
Infection of newborns and young children can result from infection by an adult carrier, making this a problem at childcare facilities. Approximately 15-40 percent of healthy humans are carriers to Staphylococcus aureus, carrying the bacteria on their skins without a sign of infection. Staphylococcus aureus has a higher infection rate amongst children, who typically do not have a strong immune system. These infections are most common in the eyes, ears, and throat and can increase the risk of Staphylococcal scalded skin syndrome.
The onset of Staphylococcal scalded skin syndrome begins with lesions on the skin. Within 24 hours, these lesions spread, causing the skin to become scarlet and painful. The skin can appear wrinkled and fragile, becoming tender and brittle. This rash may spread to the arms, legs, and torso and in newborns can be found in the diaper region and around the umbilical cord. The formation of fluid filled blisters (bullae) can develop between 24 and 48 hours after the initial legion. These bullae can be found in the armpits, nose, ears, and groin.