Staphylococcal scalded skin syndrome: Difference between revisions
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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 | ||
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
- Bactrim 10mg/kg/d in 2 divided doses x7-10d
- Vancomycin 10-15mg/kg/d in 2 divided doses up to 1 gm q12hr
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.