Staphylococcal scalded skin syndrome mimicking child abuse by burning

Child abuse by burning comprises 6-20% of all child abuse cases, but misdiagnosis may arise in cases of some medical conditions. We present two cases of suspected inflicted burns, later diagnosed as staphylococcal scalded skin syndrome (SSSS). In case 1, a 6-month-old girl was referred to hospital for small round ulcerations on the face and abdomen, resembling cigarette burns. Because of the inconsistency of the mother's report (insect bites) with the injury pattern and an unstable family history, hospitalization was decided. The following day, new bullous lesions were visible on the neck and nose, indicating the natural origin of the findings, finally diagnosed as SSSS. In case 2, a 2-month-old boy was hospitalized for erythema, with bullous lesions on the abdomen. He was transferred to another hospital, with suspected congenital or autoimmune skin disorder but negative searches led to a diagnosis of inflicted scalds: a report was sent to the judicial authorities, and the child was entrusted to his grandparents. In fact, a review of the clinical documentation showed that, in the second hospitalization, new erythematous and bullous lesions had been described, which could not be ascribed to inflicted injuries. Child abuse was finally ruled out, and SSSS was diagnosed. In cases of suspected inflicted child burns, observation during hospitalization may reveal changes in lesions, ascribed to the evolution of medical conditions. SSSS diagnosis is mainly based on clinical grounds but, if the suspicion of abuse remains, isolation and phage typing of Staphylococcus aureus from nasal, pharyngeal or cutaneous swabs may confirm the diagnosis.