Blistering Hot Topic: A Rare Case of Staphylococcal Scalded Skin Syndrome

Staphylococcal scalded skin syndrome (SSSS) results from dermatological infection with toxin-producing Staphylococcus (S.) aureus, consequently leading to exfoliative epidermal sequelae. This infection can be life-threatening, but generally resolves with an antibiotic regimen, and typically affects children under the age of two, with rare occurrence in children over the age of six. This case involves an eight-year-old unimmunized female, with no significant past medical history, who presented to an outpatient pediatric clinic with concerns of a painful rash that began on the face within 24 hours, subsequently extending into the neck and trunk. Physical exam was pertinent for blanching, erythematous macules, with well-demarcated borders on the affected areas, alongside scaling and skin denudation behind the right ear and upon the right upper chest. There was pain to light palpation in all affected areas. Rapid strep test results in the clinic were negative. The patient was sent home with instructions to initiate a clindamycin regimen and follow up after completion of treatment. Due to worsening rash the following day, the patient was taken to a tertiary care hospital, where she was evaluated and diagnosed with SSSS. This case demonstrates an occurrence of SSSS at an atypical age, underscoring the importance of including SSSS as a differential diagnosis for all pediatric rashes.