Staphylococcal scalded skin syndrome
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Introduction
Staphlococcal toxin-mediated epidermolytic disease characterized by erythema, wide-spread detachment of superficial epidermal layers, resembling scalding.
Etiology
- Staphylococcus aureus, phage group II, largely type 71
- exotoxin (exfoliation) A
- exotoxin (exfoliation) B
- derived from primary colonization
- exotoxin is transported hematogenously to the skin
Epidemiology
- most common in neonates during 1st 3 months of age
- rare in infants, children & adults
- adults with immunodeficiency or renal failure
Pathology
- acantholysis
- intraepidermal cleavage with splitting within or below the stratum granulosum
- exotoxin may produce symptoms at the site of toxin production
- purulent conjunctivitis
- otitis media
- nasopharyngeal infection
- renal clearance of exotoxin, thus predilection for neonates & adults with renal insufficiency[3]
Clinical manifestations
- bullous impetigo
- diffuse, ill-defined erythema
- within 24 hours, skin becomes tender with epidermolysis
- site of infection is usually distant from site of skin damage[4]
- major sites of involvement include face, retroauricular area & neck[4]
- mucous membranes are not involved
- Nikolsky's sign
- may be associated with systemic symptoms[4]
- healing occurs spontaneously in 5-7 days
* image[4]
Laboratory
- gram stain shows gram positive cocci only at site of colonization
- bacterial culture from site of suspected primary infection
- skin biopsy
Complications
- death may occur in adults with renal insufficiency &/or immunosupression or infants with severe disease[4]
Differential diagnosis
Management
- referral to dermatologist[2]
- baths or compresses for debridement of necrotic epidermis
- topical antimicrobial agents for impetigo lesions
- systemic antibiotics
- replace water & electrolyte losses
More general terms
References
- ↑ Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 626-27
- ↑ 2.0 2.1 Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
- ↑ 3.0 3.1 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Elkston CA, Elkston DM Bacterial Skin Infections: More Than Skin Deep. Medscape. July 19, 2021 https://reference.medscape.com/slideshow/infect-skin-6003449