Staphylococcal scalded skin syndrome: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*[[Rash]] progresses from erythroderma to extensive areas of exfoliation | *[[Rash]] progresses from erythroderma 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 | ||
*No mucous membrane involvement (differentiate from [[SJS]]/TENS) | *No mucous membrane involvement (differentiate from [[SJS]]/TENS) | ||
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==Evaluation<ref>Randall WK et al. Staphylococcal Scalded Skin Syndrome Workup. eMedicine. Oct 28, 2015. http://emedicine.medscape.com/article/788199-workup.</ref>== | ==Evaluation<ref>Randall WK et al. Staphylococcal Scalded Skin Syndrome Workup. eMedicine. Oct 28, 2015. http://emedicine.medscape.com/article/788199-workup.</ref>== | ||
*PCR for toxin if available | *PCR for toxin if available | ||
*CBC - leukocytosis, though normal WBC level oftenly | *CBC - [[leukocytosis]], though normal WBC level oftenly | ||
*ESR elevation | *ESR elevation | ||
*Monitor electrolytes, renal function closely in severe disease | *Monitor electrolytes, renal function closely in severe disease | ||
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[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:ID]] | |||
Revision as of 20:39, 6 October 2019
Background
- Caused by Staph aureus
- Most patients <2yr old, nearly all <6 yr old
Clinical Features
- Rash progresses from erythroderma 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 eruption
- 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
- 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
References
- ↑ Randall WK et al. Staphylococcal Scalded Skin Syndrome Workup. eMedicine. Oct 28, 2015. http://emedicine.medscape.com/article/788199-workup.