Staphylococcal scalded skin syndrome

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Background

  • Caused by Staph aureus
  • Bacteria release exotoxin which breaks down desmosomes
    • Exotoxin spread via bloodstream, therefore blisters not infected
  • Most patients <2yr old, nearly all <6 yr old

Clinical Features

Infant with Staphylococcal scalded skin syndrome
PMC3807844 CRIM.DM2013-376060.001.png
  • Rash progresses from erythroderma (classically perioral) to extensive areas of exfoliation
  • Systemic symptoms (malaise, fever, irritability, skin tenderness) are common
  • Nikolsky sign (separation of epidermis when pressure is applied) is present
  • No mucous membrane involvement (differentiate from SJS/TENS)

Differential Diagnosis

Erythematous rash

Evaluation[1]

  • PCR for toxin if available
  • CBC - leukocytosis, though normal WBC level oftenly
  • ESR elevation
  • Monitor electrolytes, renal function closely in severe disease
  • Blood cultures variably positive (more often pos in adults)
  • CXR to rule out pneumonia

Management

Antibiotic Options

Disposition

  • Transfer to burn center if diffuse
  • Localized infection may discharge home with follow up

See Also

External Links

Pediatric EM Morsels: Staph Scalded Skin Syndrome

References

  1. Randall WK et al. Staphylococcal Scalded Skin Syndrome Workup. eMedicine. Oct 28, 2015. http://emedicine.medscape.com/article/788199-workup.
  2. Braunstein I, Wanat KA, Abuabara K, McGowan KL, Yan AC, Treat JR. Antibiotic sensitivity and resistance patterns in pediatric staphylococcal scalded skin syndrome. Pediatr Dermatol. 2014;31(3):305-308. doi:10.1111/pde.12195