Scalded skin syndrome

Alternative names 
Ritter disease; Staphylococcal scalded skin syndrome (SSS)

Scalded skin syndrome is a skin infection characterized by damage to the skin with marked shedding (exfoliation). It usually affects infants and children under the age of 5.

Causes, incidence, and risk factors

Scalded skin syndrome is caused by infection with certain strains of a bacteria called staphylococcus. During the infection, the staphylococci produce a poison (exotoxin) that is responsible for the skin damage. Onset of the illness may be heralded by fever and skin tenderness.

The effects of the toxin first produces reddening of the skin. Fluid collects beneath the skin loosening it. Subsequently, light rubbing of the skin may pull away large sheets of skin leaving a raw red base (this effect is called the Nikolsky sign). These bare areas dry out and crust over.

It is found most commonly in infants and very young children.


  • fever  
  • 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)  
  • large areas of skin peel or fall away (exfoliation or desquamation)  
  • painful skin  
  • infant appears quite ill

Signs and tests

  • positive Nikolsky’s sign (skin slipping off when rubbed)

Tests include:

  • Complete blood count (CBC)  
  • cultures of the skin and throat (often yield staphylococci)  
  • skin biopsy (done only in rare cases where diagnosis is in question, such as when the skin condition may be due to a drug reaction known as toxic epidermal necrolysis or TEN)  
  • check of electrolytes to see if fluid loss has caused difficulties


Intravenous antibiotics that are specific for staphylococcus are given to help fight the infection. Because much fluid is lost through the open skin, supplemental intravenous fluid is important to prevent dehydration.

Moist compresses to the skin may improve comfort. An emollient may be applied to keep the skin moist. Healing begins in about 10 days following treatment.

Expectations (prognosis)

The prognosis is usually excellent. A full recovery is expected.


  • severe bloodstream infection (septicemia)  
  • fluid regulation problems causing dehydration or electrolyte imbalance  
  • poor temperature control (in young infants)  
  • spread to deeper skin infection (cellulitis)

Calling your health care provider

Call your health care provider or go to the emergency room if symptoms of this disorder appear.


The disorder may not be preventable. Prompt treatment of any staphylococcus infection may be helpful.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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