Staphylococcal Scalded Skin Syndrome

Basics

Description

  • Specific strains of Staphylococcus aureus (SA) infection causes exfoliative exotoxin release and resulting epidermis separation:
    • Primary infection at a distant location or due to SA colonization
    • Toxin disseminates hematogenously and breaks down desmoglein 1: desmosomes connecting keratinocytes in the superficial epidermis
    • Results in extensive and generalized bullae and desquamating rash
  • Typically affects infants and children <6 yr of age:
    • Infants and children lack antibody against exotoxin and have decreased renal clearance of toxin compared to healthy adults
  • Less common but more severe and higher mortality in adults:
    • Risk factors: Severe kidney disease and dialysis patients, immunocompromised states including HIV, malignancy and chemotherapy, diabetes

Etiology

  • Exfoliative toxins A and B, generated by approximately 5% of SA bacteria that infect humans
  • Primary SA infection or colonization may not be clinically apparent:
    • Symptomatic prodrome in some patients of generalized symptoms or URI symptoms
    • Most common sources:
      • Nasopharyngeal colonization
      • Conjunctivitis
      • Otitis
      • Break of skin barrier: Circumcision wound, diaper dermatitis/cellulitis/impetigo, omphalitis
      • Indwelling lines and hemodialysis catheters
  • Often, no site of primary infection identified
  • Hematogenous spread of the toxin results in diffuse epidermal symptoms

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