Staphylococcal scalded skin syndrome is a toxin-mediated erythroderma with hematogenous spread. Early skin findings include erythema, pain, and exfoliation, which is commonly seen on the face and intertriginous spaces. Large flaccid bullae often form and may have a wrinkled appearance, but the skin will soon start to peel as the bullae become unroofed. Nikolsky sign is positive, which occurs when application of pressure to the bullae results in separation of the the epidermis, but this is not seen in bullous impetigo. There may be large areas of desquamation. The skin underneath the bulla is erythematous, moist, and shiny, but can erode, fissure, and crust as it heals. These patients will also have systemic symptoms and will ultimately require inpatient treatment with fluids and antibiotics.