Emergency Department and Inpatient Clinical Pathway for the Evaluation and Management of Staphylococcal Scalded Skin Syndrome
Team Assessment
- History and Physical
- Assess VS, hydration
- Review Differential Diagnosis
- Clinical Photos
Sepsis huddle as indicated
Features Consistent with SSSS
- Pain Management
- Acetaminophen, ibuprofen, IV ketorolac as needed
- Blood, skin cultures not routinely recommended
- Antibiotics
- IV Cefazolin
- Consider PO cephalexin for children who are able to tolerate PO
- Hydration
- IVF (NS bolus, MIVF) as indicated
Diagnosis early in the disease course can be challenging. Look for painful erythroderma accentuated on face, neck and skin folds.
Admit
Inpatient Management
- Continue cefazolin or cephalexin
- Hydration
- IVF as indicated, advance to PO as tolerated
- Pain Management
- Acetaminophen, ibuprofen, IV ketorolac as needed
- Inpatient Gentle Skin Care
- Expect skin desquamation to continue
- Consult Dermatology for new symptoms or not improving
Discharge Criteria
- Improved pain, fever curve
- Tolerating PO cephalexin, fluids
- PO cephalexin to complete 7–10 days total
- Discharge Skin Care Recommendations
Evidence
- Pediatric Staphylococcal Scalded Skin Syndrome: A Systematic Review of the Literature to Inform Work-up and Management
- Staphylococcal Scalded Skin Syndrome: Clinical Features, Ancillary Testing, and Patient Management
- Antibiotic Sensitivity and Clinical Outcomes in Staphylococcal Scalded Skin Syndrome
- Recognizing and managing Staphylococcal Scalded Skin Syndrome in the Emergency Department
- Demographic Characteristics, Clinical Features, and Optimal Management of Hospitalized Patients with Staphylococcal Scalded Skin Syndrome
CHOP Programs