Overview
Also known as staphylococcal epidermal necrolysis, staphylococcal scalded skin syndrome (SSSS) describes the formation of vesicles and bullae, resulting in epidermal exfoliation due to an exotoxin produced by Staphylococcus aureus.
Nearly all cases are in young children (<6 years old), however, it can occur in adults with immunocompromised states.
Pathophysiology
Staphylococcus aureus produces exfoliative toxins that target desmoglein, a molecule found in the superficial epidermis that is important for cell adhesion, resulting in its cleavage and desquamation of the skin.
Presentation
Features of SSSS include:
- A prodrome of fever, malaise, and irritability
- A tender, erythematous rash follows
- This may cause vesicles and bullae and desquamation follows, resulting in leaving behind a raw and tender surface
- Nikolsky’s sign is positive – rubbing the skin causes exfoliation
- There may be associated conjunctivitis and stomatitis
Diagnosis
Overview
- Infection site sample culture – may identify Staphylococcus aureus
- Blood cultures – may identify Staphylococcus aureus
- C-reactive protein – may be elevated
- Toxin polymerase chain reaction (PCR) – may identify causative toxins
Management
Overview
Management involves the following:
- Intravenous fluids – a lot of fluid can be lost from the desquamated skin
- Intravenous antibiotics – often flucloxacillin or erythromycin if allergic
- Wound care – managed similarly to burns including emollients and non-adherent dressings
