STAPHYLOCOCCAL scalded skin syndrome (SSSS) is the term used to define a potentially life-threatening, blistering skin disease caused by exfoliative toxins (ETs) of certain strains of Staphylococcus aureus. The syndrome belongs to a wide spectrum of staphylococcal infections that range in severity from localized bullous impetigo to a generalized cutaneous involvement characterized by extensive blistering with superficial denudation and subsequent desquamation of the skin. SSSS is so-named because of its staphylococcal etiology and its remarkable resemblance to the clinical picture of scalding.

HISTORY

The original description of the syndrome dates back to 1878, when Ritter von Rittershain, director of an orphanage in Prague, reported approximately 300 cases of dermatitis exfoliativa neonatorum. A relationship between the disease and staphylococci was perceived at the beginning of the 20th century, but only in the early 1950s did the link between bullous impetigo and phage group 2 staphylococci become evident. Lyell's report on toxic epidermal necrolysis (TEN) in 1956 drew attention to the similarities between this drug-induced condition and the appearance of extensive scalding, but also led to a period of confusion between nonbacterial (immune-mediated) TEN and bacterial (staphylococcal) toxin-mediated scalded skin syndrome. In the early 1970s, the development of a murine model of the staphylococcal disease clarified the situation.

Nowadays, SSSS is clearly distinguished from other diseases of generalized epidermal necrolysis and the term Ritter's disease is still used to describe generalized SSSS in newborns.