Staphylococcal scalded skin syndrome: Difference between revisions
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==Background== | ==Background== | ||
*Caused by [[Staph aureus]] | *Caused by [[Staph aureus]] | ||
*Bacteria release exotoxin which breaks down desmosomes | |||
**Exotoxin spread via bloodstream, therefore blisters not infected | |||
*Most patients <2yr old, nearly all <6 yr old | *Most patients <2yr old, nearly all <6 yr old | ||
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[[File:OSC Microbio 21 02 SSSS.jpg|thumb|Infant with Staphylococcal scalded skin syndrome]] | [[File:OSC Microbio 21 02 SSSS.jpg|thumb|Infant with Staphylococcal scalded skin syndrome]] | ||
[[File:PMC3807844 CRIM.DM2013-376060.001.png|thumb|]] | [[File:PMC3807844 CRIM.DM2013-376060.001.png|thumb|]] | ||
*[[Rash]] progresses from erythroderma to extensive areas of exfoliation | *[[Rash]] progresses from erythroderma (classically perioral) to extensive areas of exfoliation | ||
*Systemic symptoms (malaise, [[fever]], irritability, skin tenderness) are common | *Systemic symptoms (malaise, [[fever]], irritability, skin tenderness) are common | ||
*Nikolsky sign (separation of epidermis when pressure is applied) is present | *Nikolsky sign (separation of epidermis when pressure is applied) is present | ||
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===[[Antibiotic]] Options=== | ===[[Antibiotic]] Options=== | ||
*[[Nafcillin]] 100mg/kg/d IV in 4 divided doses '''OR''' 50mg/kg/d in 4 divided doses PO x7-10d | *[[Nafcillin]] 100mg/kg/d IV in 4 divided doses '''OR''' 50mg/kg/d in 4 divided doses PO x7-10d | ||
*[[Dicloxacillin]] 125-500mg PO q6h x7-10 days | |||
*[[Penicillin G Procaine]] (300K U/d IM for <30 kg, 600K to 1 million U/d IM for >30 kg) | *[[Penicillin G Procaine]] (300K U/d IM for <30 kg, 600K to 1 million U/d IM for >30 kg) | ||
*[[Amoxicillin/Clavulanate]] 45mg/kg/d PO in 2 divided doses x 7-10d | *[[Amoxicillin/Clavulanate]] 45mg/kg/d PO in 2 divided doses x 7-10d | ||
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*If possible [[MRSA]]: | *If possible [[MRSA]]: | ||
**[[Clindamycin]] 40mg/kg/d IV or PO in 4 divided doses x7-10d | **[[Clindamycin]] 40mg/kg/d IV or PO in 4 divided doses x7-10d | ||
***Reports of high clindamycin resistance in SSSS<ref>Braunstein I, Wanat KA, Abuabara K, McGowan KL, Yan AC, Treat JR. Antibiotic sensitivity and resistance patterns in pediatric staphylococcal scalded skin syndrome. Pediatr Dermatol. 2014;31(3):305-308. doi:10.1111/pde.12195</ref> | |||
**[[Bactrim]] 10mg/kg/d in 2 divided doses x7-10d | **[[Bactrim]] 10mg/kg/d in 2 divided doses x7-10d | ||
**[[Vancomycin]] 10-15mg/kg/d in 2 divided doses up to 1 gm q12hr | **[[Vancomycin]] 10-15mg/kg/d in 2 divided doses up to 1 gm q12hr | ||
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==See Also== | ==See Also== | ||
*[[Staphylococcus aureus]] | *[[Staphylococcus aureus]] | ||
==External Links== | |||
[https://pedemmorsels.com/staph-scalded-skin-syndrome/ Pediatric EM Morsels: Staph Scalded Skin Syndrome] | |||
==References== | ==References== | ||
Latest revision as of 17:49, 13 February 2021
Background
- Caused by Staph aureus
- Bacteria release exotoxin which breaks down desmosomes
- Exotoxin spread via bloodstream, therefore blisters not infected
- Most patients <2yr old, nearly all <6 yr old
Clinical Features
- Rash progresses from erythroderma (classically perioral) to extensive areas of exfoliation
- Systemic symptoms (malaise, fever, irritability, skin tenderness) are common
- Nikolsky sign (separation of epidermis when pressure is applied) is present
- No mucous membrane involvement (differentiate from SJS/TENS)
Differential Diagnosis
- Erythema Multiforme
- Staphylococcal scalded skin syndrome
- Erythroderma
- Toxic Shock Syndrome
- Drug rash
- Pemphigus vulgaris
Erythematous rash
- Positive Nikolsky’s sign
- Febrile
- Staphylococcal scalded skin syndrome (children)
- Toxic epidermal necrolysis/SJS (adults)
- Afebrile
- Febrile
- Negative Nikolsky’s sign
- Febrile
- Afebrile
Evaluation[1]
- PCR for toxin if available
- CBC - leukocytosis, though normal WBC level oftenly
- ESR elevation
- Monitor electrolytes, renal function closely in severe disease
- Blood cultures variably positive (more often pos in adults)
- CXR to rule out pneumonia
Management
- Often requires inpatient therapy, Fluid Resuscitation, parenteral antibiotics
Antibiotic Options
- Nafcillin 100mg/kg/d IV in 4 divided doses OR 50mg/kg/d in 4 divided doses PO x7-10d
- Dicloxacillin 125-500mg PO q6h x7-10 days
- Penicillin G Procaine (300K U/d IM for <30 kg, 600K to 1 million U/d IM for >30 kg)
- Amoxicillin/Clavulanate 45mg/kg/d PO in 2 divided doses x 7-10d
- Cefazolin 100mg/kg/d IV in 4 divided doses
- Cephalexin 40mg/kg/d in 4 divided doses x 7-10d
- If possible MRSA:
- Clindamycin 40mg/kg/d IV or PO in 4 divided doses x7-10d
- Reports of high clindamycin resistance in SSSS[2]
- Bactrim 10mg/kg/d in 2 divided doses x7-10d
- Vancomycin 10-15mg/kg/d in 2 divided doses up to 1 gm q12hr
- Clindamycin 40mg/kg/d IV or PO in 4 divided doses x7-10d
Disposition
- Transfer to burn center if diffuse
- Localized infection may discharge home with follow up
See Also
External Links
Pediatric EM Morsels: Staph Scalded Skin Syndrome
References
- ↑ Randall WK et al. Staphylococcal Scalded Skin Syndrome Workup. eMedicine. Oct 28, 2015. http://emedicine.medscape.com/article/788199-workup.
- ↑ Braunstein I, Wanat KA, Abuabara K, McGowan KL, Yan AC, Treat JR. Antibiotic sensitivity and resistance patterns in pediatric staphylococcal scalded skin syndrome. Pediatr Dermatol. 2014;31(3):305-308. doi:10.1111/pde.12195