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Scalded skin syndrome

Ritter disease; Staphylococcal scalded skin syndrome; SSS

Definition

Scalded skin syndrome (SSS) is a skin infection caused by staphylococcus bacteria in which the skin becomes damaged and sheds.

Causes

Scalded skin syndrome is caused by infection with certain strains of staphylococcus bacteria. The bacteria produce a toxin that causes skin damage. The damage creates blisters, as if the skin were scalded by heat. These blisters can occur at areas of the skin away from the initial site.

SSS is found most commonly in infants and children under the age of 5.

Symptoms

Symptoms may include any of the following:

Blisters
Fever
Large areas of skin peel or fall away (exfoliation or desquamation)
Painful skin
Redness of the skin (erythema), which spreads to cover most of the body
Skin slips off with gentle pressure, leaving wet red areas (Nikolsky sign)

Exams and Tests

Your health care provider will perform a physical exam and look at the skin. The exam may show that the skin slips off when it is rubbed (positive Nikolsky sign).

Tests may include:

Complete blood count (CBC)
Cultures of the skin, throat and nose, and blood
Electrolyte test
Skin biopsy (in rare cases)

Treatment

Antibiotics are given by mouth or through a vein (intravenously; IV) to help fight the infection. IV fluids are also given to prevent dehydration. Much of the body's fluid is lost through open skin.

Moist compresses to the skin may improve comfort. You can apply a moisturizing ointment to keep the skin moist. Healing begins about 10 days after treatment.

Outlook (Prognosis)

A full recovery is expected.

Possible Complications

Complications that may result include:

Abnormal level of fluids in the body causing dehydration or electrolyte imbalance
Poor temperature control (in young infants)
Severe bloodstream infection (septicemia)
Spread to deeper skin infection (cellulitis)

When to Contact a Medical Professional

Contact your provider or go to the emergency room if you have symptoms of this disorder.

Prevention

The disorder may not be preventable. Treating any staphylococcus infection quickly can help.

References

Kliegman RM, St. Geme JW, Blum NJ, et al. Cutaneous bacterial infections. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 706.

Paller AS, Mancini AJ. Bacterial, mycobacterial, and protozoal infections of the skin. In: Paller AS, Mancini AJ, eds. Paller and Mancini-Hurwitz Clinical Pediatric Dermatology. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 14.

Pulia M, May LS. Skin and soft tissue infections. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 126.

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Review Date: 12/31/2023

Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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