Staphylococcal scalded skin syndrome

Background

• Most pts <2yr old, nearly all <6 yr old

Diagnosis

• 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

Treatment

• Often requires inpt therapy, fluid resuscitation, parenteral antibiotics
• Antibiotics
  • Nafcillin 100 mg/kg/d IV in 4 divided doses OR 50 mg/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 45 mg/kg/d PO in 2 divided doses x 7-10d
  • Cefazolin 100 mg/kg/d IV in 4 divided doses
  • Cephalexin 40 mg/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 10 mg/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 d/c home w/ f/u

Source

Tintinalli