Staphylococcical scalded skin syndrome: a case series description of a rare and critical disease in a tertiary pediatric center

Background: Staphylococcal-scalded skin syndrome (SSSS) is a potentially life-threatening disorder characterized by superficial skin blistering caused by exfoliative toxins produced by Staphylococcus aureus. This study aimed to investigate SSSS in a cohort of children admitted at a tertiary pediatric hospital in Italy. Methods: Patients discharged with the diagnosis of staphylococcal infection and of SSSS between January 2010 and March 2023 were retrospectively identified using ICD-9-CM codes (695.81 and 041.1, respectively). Medical records were reviewed to extract epidemiological, clinical, and hematological data, treatment details (type and duration), length of hospitalization, and outcomes. Results: Among 971 children with staphylococcal infection, 21 (2.1%) were diagnosed with SSSS. The mean age of 36.8 (interquartile range, IQR 8.5-50.7) months, with 86% under 5 years old. Incidence peaked in winter, summer, and autumn (27.3%, respectively), possibly due to viral co-infection. The admissions/year rate did not indicate an upward trend. Almost all children were healthy. No previous trauma, insect bites, drugs, vaccines, or allergy history have been reported; atopic dermatitis has been reported in one girl. Leukocytosis and elevated C-reactive protein were uncommon. Severe complications were seen in three cases (14.3%): one with severe dehydration with hyponatremia, one with sepsis and the last with Herpes Simplex Virus 1 (HSV1) infection. S. aureus was detected by culture from skin lesions in nine cases (42.9%), by real-time polymerase chain reaction (RT-PCR) assay on vesicle fluid in seven (33%), and by throat culture in one (4.7%). Drug susceptibility tests ruled out resistance and all children received intravenous (IV) antibiotics: oxacillin in 76% of patients, while teicoplanin and clindamycin in 19%. The median duration of IV and oral antibiotic therapy was 12.8 days (IQR 10-14). Only one patient was treated with IV immunoglobulin. The median hospitalization length was 7.8 days (IQR 5-9). All our cases had a favorable outcome. Conclusion: Demographic, clinical. and hematological features of children with SSSS in this study were comparable with those reported in the literature. The improved awareness of pediatricians should faster diagnosis, which is mainly clinical, and early assessment of appropriate management.