When should I consider referring a patient with SSSS to a specialist for further management?

While the provided guidelines do not explicitly detail referral criteria for Staphylococcal Scalded Skin Syndrome (SSSS), referral to a specialist for further management should be considered based on the severity of the infection and the presence of high-risk features, particularly those indicating sepsis ².

You should refer a patient for emergency medical care immediately if they have suspected sepsis and meet any high-risk criteria ². For children under 16, high-risk criteria for sepsis include:

• Skin: Mottled or ashen appearance, cyanosis of skin, lips or tongue, or a non-blanching petechial or purpuric rash ².
• Other signs: Objective evidence of new altered mental state, a raised respiratory rate (25 breaths per minute or more), systolic blood pressure 90 mmHg or less, a raised heart rate (more than 130 beats per minute), or not having passed urine in the previous 18 hours ².

Additionally, if a patient's immunity is impaired by drugs or illness and they meet any moderate to high-risk criteria for sepsis, they should also be referred for emergency medical care ².

Although specific to atopic eczema, general principles for severe bacterial skin infections may also guide referral. For instance, children with atopic eczema are referred for specialist dermatological advice if their atopic eczema is associated with severe and recurrent infections, especially deep abscesses or pneumonia ¹. Urgent (within 2 weeks) referral for specialist dermatological advice is also indicated if treatment of bacterially infected atopic eczema has failed ¹.