Staphylococcal scalded skin syndrome (SSSS) is an acute epidermolytic dermatosis mediated by toxins produced by group II Staphylococcus aureus . It mainly affects children under 5 years old and is characterized by diffuse erythema, tenderness to palpation, and subsequent superficial epidermal peeling, giving the typical “scalded skin” appearance. Mucous membranes are spared, distinguishing it from other bullous diseases. Diagnosis is clinical. Complications such as dehydration, shock, hypothermia, sepsis, and death may occur. Extensive skin denudation can facilitate secondary infection and requires rigorous supportive care. Prognosis in children is usually favorable, with possible spontaneous regression in 2–3 weeks, and treatment is based on antibiotic therapy and supportive measures in cases of electrolyte disturbances and impaired thermoregulation. A 5-month-old boy from Sorocaba presented with perioral scaly lesion and redness for 1 week, worsening over the last 3 days. The condition started with red patches with dark borders, unresponsive to antihistamines. After 1 day, he developed auricular edema and worsening erythema, and was prescribed dexamethasone. The lesions progressed to the thoracic and dorsal regions, associated with fever; he received two injections of adrenaline, paracetamol, prednisone, amoxicillin, and hydroxyzine. With further worsening of the skin condition, he was again treated with adrenaline and injectable antihistamine, without improvement, and later developed eye swelling with purulent discharge. He was hospitalized 4 days earlier and treated with hydroxyzine, oxacillin, and antihistamines. On exam, he had hyperemic, scaly lesions with crusts extending over cervical, facial, retroauricular, and thoracic regions. Laboratory tests showed lymphopenia (1,699/mm³), left shift (segmented neutrophils 7,286/mm³), hyponatremia (132 mEq/L), elevated AST (58 U/L) and normal CRP (0.5 mg/dL). The diagnostic hypothesis was SSSS. This case illustrates a typical SSSS presentation in an infant, with rapid progression and lack of response to antihistamines, and absence of mucosal involvement. Laboratory findings of lymphopenia, hyponatremia, and elevated AST support an infectious process. Oxacillin use was appropriate. Ocular discharge suggests secondary infection, warranting continuous monitoring. This case reinforces the importance of SSSS as a differential diagnosis in children with acute, rapidly progressive dermatosis.
Seixas et al. (Sun,) studied this question.