From the Guidelines
The treatment of Staphylococcal Scalded Skin Syndrome (SSSS) requires prompt medical attention and typically involves hospitalization, with the cornerstone of treatment being intravenous anti-staphylococcal antibiotics, such as vancomycin or clindamycin, as first-line options 1. The choice of antibiotic should be guided by local epidemiology and susceptibility patterns, as well as the severity of the disease.
- Vancomycin (15-20mg/kg IV every 8-12 hours) is a suitable option for patients with severe disease or those who are at risk of complications 1.
- Clindamycin (600-900mg IV every 8 hours for adults; 25-40mg/kg/day divided every 6-8 hours for children) is an alternative for patients with penicillin allergies or in areas with high MRSA prevalence 1.
- Treatment duration is typically 7-14 days, but should be individualized based on the patient's clinical response 1. Supportive care is equally important and includes:
- Fluid management to replace losses from denuded skin
- Pain control
- Temperature regulation
- Meticulous wound care with gentle cleansing and non-adherent dressings Corticosteroids are contraindicated as they may worsen the condition. SSSS is caused by exfoliative toxins produced by certain Staphylococcus aureus strains that specifically target desmoglein-1 in the superficial epidermis, causing the characteristic skin sloughing. With appropriate treatment, most patients recover completely within 10-14 days without scarring, as the toxin-mediated damage is limited to the superficial epidermis. It is essential to note that the treatment of SSSS should prioritize the use of intravenous antibiotics, as oral antibiotics may not be sufficient to penetrate the skin and reach the site of infection effectively 1. In addition, the use of rifampin as a single agent or as adjunctive therapy for the treatment of SSSS is not recommended due to the risk of resistance development 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Bacteriologic studies to determine the causative organisms and their susceptibility to oxacillin should always be performed. In severe staphylococcal infections, therapy with oxacillin should be continued for at least 14 days.
The treatment for Staphylococcal Scalded Skin Syndrome (SSSS) is oxacillin. The recommended dosage is 1 gram IM or IV every 4 to 6 hours for severe infections, and therapy should be continued for at least 14 days 2.
- The dosage may vary based on the severity of the infection and the patient's overall condition.
- It is essential to determine the causative organisms and their susceptibility to oxacillin through bacteriologic studies.
- Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative.
From the Research
Treatment Overview
The treatment for Staphylococcal Scalded Skin Syndrome (SSSS) involves prompt empiric treatment with intravenous anti-staphylococcal antibiotics, such as nafcillin, oxacillin, or flucloxacillin 3.
Antibiotic Treatment
- The choice of antibiotic may depend on the patient's allergy status, with clarithromycin or cefuroxime used in cases of penicillin allergy 3.
- Vancomycin may be used if the patient is not improving, critically ill, or in communities where the prevalence of methicillin-resistant S. aureus is high 3.
- Clindamycin may be considered as an adjuvant therapy, as it can inhibit the production of exotoxins from bacteria ribosome 4, 5.
- However, clindamycin monotherapy should be avoided due to high resistance rates 6.
Supportive Care
- Fluid replacement with Ringer solution may be necessary to balance fluid loss due to exfoliation of the skin 4.
- Topical application of cotrimoxazole may also be considered as part of the treatment regimen 4.
- Avoidance of drugs that reduce renal function is recommended 4.