Erythematous, red skin often with peeling erosions about the mouth, neck and axilla is typical.

STAPHYLOCOCCAL SCALDED SKIN SYNDROME

Staphylococcal scalded skin syndrome (SSSS) is a localized infection by coagulase-positive group II Staphylococcus aureus (especially strain 71) that causes diffuse skin changes mediated via the release of a toxin.

• In one study of 84 patients, the mean age was 3.1 (plus or minus 2.4) years. About a third of the patients had a history of fever. 42% had an upper respiratory tract infection in the 2 weeks preceding the SSSS diagnosis. Pain and skin tenderness were experienced by most.
• Drug-induced epidermal necrolysis (DEN) should be excluded.  
• One study showed that Staphylococcus aureus cultured from the skin was non-toxin producing in 69% of cases.   Thus, the true offending Staphylococcus was somewhere else in the body. Thus, the correct diagnosis is based upon the clinical picture rather than laboratory studies.
• The target for the toxins has been identified as desmoglein-1, a desmosomal glycoprotein which plays an important role in maintaining cell-to-cell adhesion in the superficial epidermis.   The toxin cleaves the extracellular domain of desmoglein-1, resulting in disruption of intercellular adhesion and formation of superficial blisters.

Clinical

The face is often covered with crust like an impetigo pie. A very superficial and thin layer of the skin may slough off. This is particularly common about the mouth, on the neck, and axilla. Thin-walled bulla may form. Nikolsky sign is positive.

Treatment

The patient is usually hospitalized. IV antistaphylococcal antibiotics are in order. Supportive care including temperature regulation, fluid management (rehydration), nutrition, and skin care should be considered. Corticosteroids are contraindicated. Pain management is usually necessary and opioids are commonly needed. Complications such as pneumonia and sepsis may occur, but are rare.

RegionalDerm

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