Staphylococcal Scalded Skin Syndrome

Basics

Description

  • 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

Etiology

  • 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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