This condition generally affects children < 5 years of age, and can be a severe and potentially life threatening illness, particularly in neonates.
It is caused by dissemination of Staphylococcus aureus exfoliative toxins which causes lysis within the superficial layers of the skin, resulting in large thin-walled bullae which quickly break down, leaving raw denuded areas.
These lesions resemble scalds from hot liquid, hence the name of the condition.
The primary site of staphylococcal infection:
Neonates – periumbilical infection, conjunctivitis, bullous impetigo and “septic spots” are common sites
Infants – infected eczema, paronychia, boils, impetigo and skin trauma are common causes
Initial signs and symptoms
Generalised erythroderma (blanching) which may be scarletiniform (sandpaper-like) or tender on palpation
Erythroderma progresses to the formation of large, thin walled, fluid-filled bullae which typically occur in areas of mechanical stress (flexural areas, buttocks, hands & feet)
Gentle pressure to the skin results in separation of the upper epidermis and wrinkling of skin (Nikolsky sign)
Toxic epidermal necrolysis
Stevens Johnson syndrome
Children should be hospitalised for intravenous antibiotics