Pediatric Staphylococcal Scalded Skin Syndrome: A Systematic Review of the Literature to Inform Work-Up and Management.

Abstract

Background: Significant gaps exist in the literature regarding the work-up and management of staphylococcal scalded skin syndrome (SSSS). These include (a) the utility of ancillary testing in improving diagnostic accuracy and informing patient care, and (b) appropriate management strategies for antibiotics, fluids, and skin care. Moreover, no systematic review to date has focused on non-neonatal pediatric SSSS to provide a comprehensive analysis of the literature.

Methods: A systematic review of PubMed and OVID was conducted from 2010 to 2024 using the medical subject heading (MeSH) term 'staphylococcal scalded skin syndrome' with restriction to MeSH major topic. Studies involving neonates (< 90 days old) and premature infants (< 37 weeks' gestation) were excluded. Articles were limited to English-language studies involving human subjects.

Results: A total of 48 studies were analyzed. Laboratory evaluations, including blood counts, chemistry panels, and inflammatory markers, were found to be non-specific and did not enhance diagnostic accuracy or inform patient care. Aerobic bacterial cultures from suspected infection foci were more likely to yield positive results, while blood cultures were typically sterile. Findings suggest that clindamycin does not improve outcomes in SSSS, supporting beta-lactam antibiotics as a preferred first-line treatment. Fluid resuscitation was necessary for children unable to maintain oral intake, and bland emollients were effective for skin care.

Conclusion: The findings support a "less is more" approach to both the work-up and management of SSSS, emphasizing minimal laboratory testing, targeted antibiotic use, and supportive skin care. Future research should focus on prospective studies implementing these strategies and evaluating outcomes to refine care further.