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Staphylococcal Scalded Skin Syndrome
Aka: Staphylococcal Scalded Skin Syndrome, Staphylococcus Scalded Skin Syndrome, Ritters Disease
- Epidemiology
- Typically affects age <2 years old
- Pathophysiology
- Hematologic dissemination of Staphylococcus aureus from an infectious source (e.g. Otitis Media, URI)
- Contrast with Bullous Impetigo, where localized infection spreads contiguously
- Staphylococcus aureus strains that carry exfoliative toxins A and B (only 5% of S. aureus strains)
- Breaks down desmoglein-1 resulting in Acantholysis (breakage of cell to cell adhesions)
- Similar to Pemphigus Vulgaris (which in contrast is immune mediated)
- Symptoms
- Prodrome (initial Upper Respiratory Infection)
- Otitis Media
- Pharyngitis
- Conjunctivitis
- Acute phase (initial, prior to Desquamation)
- Fever
- Malaise
- Red, scarlatiniform rash
- Red, painful skin
- Signs
- Paper-thin skin that desquamates
- Large, flaccid Blisters, especially in the flexor creases
- No mucous membrane involvement
- Positive Nikolsky Sign (on affected skin)
- Labs
- Blood Cultures
- Bacteremia is often present in Staphylococcal Scalded Skin Syndrome
- Skin biopsy
- Exotoxin assay
- Avoid skin lesion cultures
- Lesions are sterile and will be non-diagnostic
- Management
- Admit patients with diffuse involvement to ICU or burn unit
- Intravenous antibiotics covering Staphylococcus aureus (consider MRSA coverage depending on risk)
- Systemic Corticosteroids may be used in non-toxic appearing patients
- Adjunctive measures in severe cases
- Intravenous Immunoglobulin
- Plasmapheresis
- Differential Diagnosis
- See Bullous Conditions
- Steven Johnson Syndrome
- Toxic Epidermal Necrolysis
- References
- Long (2016) Crit Dec Emerg Med 30(7):3-10