Ritter disease

Definition

Scalded skin syndrome is a skin infection characterized by damage to the skin, with marked shedding (exfoliation). It usually affects infants and children under the age of 5.

Alternative Names

Causes

Scalded skin syndrome is caused by infection with certain strains of bacteria in the Staphylococcus family. During the infection, the staphylococci produce a poison that is responsible for the skin damage. Onset of the illness may include fever and skin tenderness.

The effects of the toxin first produce reddening of the skin. Fluid collects beneath the skin, loosening it. Subsequently, light rubbing of the skin may pull away large sheets of skin leaving a raw, red base (this effect is called the Nikolsky sign). These bare areas dry out and crust over.

Scalded skin syndrome is found most commonly in infants and very young children.

Symptoms

• fever
• redness of the skin (erythema) which spreads to cover most of the body
• skin slips off with gentle pressure leaving wet red areas (Nikolsky sign)
• large areas of skin peel or fall away (exfoliation or desquamation)
• painful skin
• infant appears quite ill

Exams and Tests

• positive Nikolsky's sign (skin slipping off when rubbed)

Tests include:

• Complete blood count (CBC)
• cultures of the skin and throat (often yield staphylococci)
• skin biopsy (done only in rare cases where diagnosis is in question, such as when the skin condition may be due to a drug reaction known as toxic epidermal necrolysis or TEN)
• check of electrolytes to see if fluid loss has caused difficulties

Treatment

Intravenous antibiotics that are specific for staphylococcus are given to help fight the infection. Because much fluid is lost through the open skin, supplemental intravenous fluid is important to prevent dehydration

Moist compresses to the skin may improve comfort. An emollient may be applied to keep the skin moist. Healing begins in about 10 days following treatment.

Outlook (Prognosis)

The prognosis is usually excellent. A full recovery is expected.

Possible Complications

• severe bloodstream infection (septicemia)
• fluid regulation problems causing dehydration or electrolyte imbalance
• poor temperature control (in young infants)
• spread to deeper skin infection (cellulitis)

When to Contact a Medical Professional

Call your health care provider or go to the emergency room if symptoms of this disorder appear.

Prevention

The disorder may not be preventable. Prompt treatment of any staphylococcus infection may be helpful.