This boy was born after an uncomplicated pregnancy and delivery. On the 5th day of life, a small blister was seen on the right buttock and thigh. During the course of a few hours, erythema developed on the trunk and blisters in the napkin area. The patient was admitted to our burn centre, and the diagnosis of staphylococcal scalded skin syndrome (SSSS) was made. His vital functions and temperature remained normal. The skin was reddened and painful, with 50% of the total body area covered by blisters. The Nikolsky sign (separation of the superficial skin from the deeper layers on application of light pressure) was positive. The mucous membranes of the mouth and anus were unaffected. During the next few hours the blisters became more extensive, until they involved 90% of the total body area (fig 1).

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Figure 1

 The patient a few hours after the diagnosis of staphylococcal scalded skin syndrome, when 90% of the total body area was blistered. The child’s parents have consented to the publication of this picture.

Skin cultures showed a growth of Staphylococcus aureus, which produces exfoliative endotoxin B.¹

Treatment included administration of intravenous antibiotics and fluid.^2,3 The fluid amount was adapted to compensate for evaporation through the large wound surface. Normal body temperature was maintained with extra heat in an incubator, and pain was relieved with intravenous morphine and rectal acetominophen. The wound areas were covered with a polyurethane film (Omniderm). This semipermeable wound cover reduces water permeability and thereby fluid loss. It also creates a favourable environment for epithelisation.

On the third day after admission, epithelisation began and was complete on the 5th day. The patient was discharged home with intact skin, without scars, seven days after admission (fig 2).

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Figure 2

 The patient seven days after admission, with intact skin and no scars. The child’s parents have consented to the publication of this picture.