Case Series of Neonatal Staphylococcal Scalded Skin Syndrome from Western India

Abstract Introduction: Ritter Von Rittershain first described superficial blistering skin disorder Staphylococcal Scalded Skin Syndrome (SSSS) or Ritter disease due to exfoliative toxins (A and B) of Staphylococcus aureus . Case Presentation: We report the two cases of neonates of SSSS. The first case presented with fever, irritability, refusal to feed, and skin peeling upon pressure application. The baby was admitted to the neonatal intensive care unit (NICU), and a clinical diagnosis of SSSS was made. Improved with medication and discharged after 7 days in the first case. In the second case, the baby was shifted to NICU and was started on bubble continuous positive airway pressure, vasopressors, and was put on mechanical ventilation. The baby died on day 2. Discussion: SSSS is toxin-mediated disease; however, the cultures or biopsies are often negative for Staphylococcus . If not treated appropriately, the mortality of SSSS will be severe. The recent problem in the management of exfoliative disease caused by S . aureus is methicillin-resistant S. aureus , in which cloxacillin and flucloxacillin are helpless in therapy. The mucosal involvement, thickness level of inflammation in dermal layers, and Nikolsky sign positivity will help in differentiate SSSS from toxic epidermal necrolysis and Stevens–Johnson syndrome. The exfoliative toxin A and B detection by the Enzyme-linked Immunosorbent Assay and molecular tests is not easily available. Conclusion: The clinical diagnosis is very essential along with other supportive investigations in SSSS management. Hence, further studies should be conducted to highlight the toxin production, excretion, and inhibition for the protocol-based management of SSSS.