Staphylococcal scalded skin syndrome: Difference between revisions

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==Background==
==Background==
*Most pts <2yr old, nearly all <6 yr old
{{Skin anatomy background images}}
*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


==Diagnosis==
==Clinical Features==
*Rash progresses from erythroderma to extensive areas of exfoliation
[[File:OSC Microbio 21 02 SSSS.jpg|thumb|Infant with Staphylococcal scalded skin syndrome]]
*Systemic symptoms (malaise, fever, irritability, skin tenderness) are common
[[File:PMC3807844 CRIM.DM2013-376060.001.png|thumb|]]
*[[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
*Nikolsky sign (separation of epidermis when pressure is applied) is present
*No mucous membrane involvement (differentiate from [[SJS]]/TENS)


==Treatment==
==Differential Diagnosis==
*Often requires inpt therapy, fluid resuscitation, parenteral antibiotics
*[[Erythema Multiforme]]
*Antibiotics
*[[Staphylococcal scalded skin syndrome]]
**Nafcillin 100 mg/kg/d IV in 4 divided doses OR 50 mg/kg/d in 4 divided doses PO x7-10d
*[[Erythroderma]]
**Penicillin G procaine (300K U/d IM for <30 kg, 600K to 1 million U/d IM for >30 kg)
*[[Toxic Shock Syndrome]]
**Amoxicillin-clavulanate 45 mg/kg/d PO in 2 divided doses x 7-10d
*[[Drug rash]]
**Cefazolin 100 mg/kg/d IV in 4 divided doses
*[[Pemphigus vulgaris]]
**[[Cephalexin]] 40 mg/kg/d in 4 divided doses x 7-10d
 
**If possible MRSA:
{{Erythematous rash DDX}}
***Clindamycin 40mg/kg/d IV or PO in 4 divided doses x7-10d
 
***Bactrim 10 mg/kg/d in 2 divided doses x7-10d
==Evaluation<ref>Randall WK et al. Staphylococcal Scalded Skin Syndrome Workup. eMedicine. Oct 28, 2015. http://emedicine.medscape.com/article/788199-workup.</ref>==
***Vancomycin 10-15mg/kg/d in 2 divided doses up to 1 gm q12hr
*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<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
**[[Vancomycin]] 10-15mg/kg/d in 2 divided doses up to 1 gm q12hr


==Disposition==
==Disposition==
*Transfer to burn center if diffuse
*Transfer to burn center if diffuse
*Localized infection may d/c home w/ f/u
*Localized infection may discharge home with follow up
 
==See Also==
*[[Staphylococcus aureus]]


==Source==
==External Links==
Tintinalli
[https://pedemmorsels.com/staph-scalded-skin-syndrome/ Pediatric EM Morsels: Staph Scalded Skin Syndrome]


[[Category:Peds]]
==References==
<references/>
[[Category:Dermatology]]
[[Category:Pediatrics]]
[[Category:ID]]

Latest revision as of 18:15, 11 December 2024

Background

Normal dermal anatomy.
  • 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

Infant with Staphylococcal scalded skin syndrome
PMC3807844 CRIM.DM2013-376060.001.png
  • 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

Erythematous rash

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

Antibiotic Options

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

  1. ↑ Randall WK et al. Staphylococcal Scalded Skin Syndrome Workup. eMedicine. Oct 28, 2015. http://emedicine.medscape.com/article/788199-workup.
  2. ↑ 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
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