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Staphylococcal Scalded Skin Syndrome

Staphylococcal scalded skin syndrome is a severe skin disorder marked by epidermal erythema, peeling, and necrosis that give the skin a scalded appearance. This disorder is most prevalent in infants ages 1 to 3 months but may develop in children under age 5; it's uncommon in adults. It follows a consistent pattern of progression, and most patients recover fully. Toxic epidermal necrolysis also presents as a scalded skin syndrome.

Causes

Group 2 Staphylococcus aureus, primarily phage type 71, is the causative organism in staphylococcal scalded skin syndrome. This penicillinase-producing organism releases epidermolytic toxins that are widely disseminated from a systemic site.

Predisposing factors may include impaired immunity and renal insufficiency, which are present to some extent in the normal neonate because of immature development of these systems. Rarely, this disorder may affect adults undergoing immunosuppressive therapy.

Symptoms

SSSS usually starts with fever, irritability and widespread redness of the skin. Within 24-48 hours fluid-filled blisters form. These rupture easily, leaving an area that looks like a burn.

Characteristics of the rash include:

  • Tissue paper like wrinkling of the skin is followed by the appearance of large fluid-filled blisters (bullae) in the armpits, groin and body orifices such as the nose and ears.
  • Rash spreads to other parts of the body including the arms, legs and trunk. In newborns, lesions are often found in the diaper area or around the umbilical cord.
  • Top layer of skin begins peeling off in sheets, leaving exposed a moist, red and tender area.

Other symptoms may include tender and painful areas around the infection site, weakness, and dehydration.

Diagnostic tests

In addition to a medical history and physical examination, the diagnosis may be confirmed with a biopsy (taking a tissue sample to be examined under a microscope) and bacterial culture.

Treatment

Systemic antibiotics (usually penicillinase-resistant penicillin) to prevent secondary infections and replacement measures to maintain fluid and electrolyte balance are the most common treatments.

Prevention

As always, good hygiene can prevent the passage of the causative bacteria between people. In the event of an outbreak in a newborn nursery, members of the staff should have nasal smears taken to identify an adult who may be unknowingly carrying the bacteria and passing it on to the babies.

 

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