Staphylococcal Scalded Skin Syndrome

Basics

Results from the actions of a soluble epidermolytic/exfoliative exotoxin produced by Staphylococcus aureus:
- Produced at a distant site of infection or colonization
- Disseminates hematogenously
- Lyses desmosomes of granular cells in the superficial epidermis
- Results in generalized intradermal exfoliation
Typically affects infants and children <6 yr of age:
- Adults have specific staph antibodies allowing them to localize, metabolize, and excrete the staph toxins
- Infants and children are unable to metabolize and excrete toxin efficiently
- Infants 3–7 d of age may present with fever and diffuse blanching erythema flaccid blister with positive Nikolsky sign
- Immunocompromised adults and those with severe renal dysfunction are also susceptible
Presentation determined by age and extent of rash:
- Classic staphylococcal scalded skin syndrome
- Pemphigus neonatorum
- Bullous impetigo
- Generalized in the newborn: Ritter disease
Typically, coagulase-positive phage group II Staphylococcus:
- Phage groups I and III also implicated

Colonization often without overt infection
Concurrent infection or break of skin barrier:
- Nasopharynx
- Urinary tract
- Minor skin abrasions
- Circumcision site
- Conjunctivitis
- Umbilicus/omphalitis
- Impetigo
- Endocarditis and septicemia
Often no focus identified
Streptococcal skin infection may mimic, although less common. Gram stain of lesion may be useful

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