Having a high clinical suspicion for staphylococcal scalded skin syndrome, early diagnosis treatment, and following robust hygiene measures are imperative for the effective management of staphylococcal scalded skin syndrome. Staphylococcal scalded skin syndrome ssss is caused by systemic effects of circulating exfoliative toxins released by phage ii strains of s. Staphylococcal scalded skin syndrome ssss is a serious skin infection. Staphylococcal scalded skin syndrome ssss was suspected, so treatment with intravenous vancomycin was started. The features distinguishing this from streptococcal scarlet fever were the skin being tender to the touch and the absence of strawberry tongue or palatal exanthem. It is induced by the exfoliative toxins et of staphylococcus aureus. Apr 25, 2017 staphylococcal scalded skin syndrome ssss is a toxinmediated type of exfoliative dermatitis. It looks like the skin has been scalded or burned by hot liquid. Newborns are particularly susceptible to these exfoliative toxins. The role of gram staining in staphylococcal scalded skin syndrome. Dec 01, 2017 staphylococcal scalded skin syndrome ssss is a serious skin infection caused by the bacterium staphylococcus aureus.
Use of skin substitute dressings in the treatment of staphylococcal scalded skin syndrome in neonates and young infants mga. Staphylococcal scalded skin syndrome ssss is caused by toxigenic strains of staphylococcus aureus, a grampositive, catalasepositive bacterium. The diagnosis of staphylococcal scalded skin syndrome ssss was clinically. The management of staphylococcal scalded skin syndrome in. If you are concerned that your child has symptoms of staphylococcal scalded skin syndrome ssss, take them to your doctor as soon as possible or call triple zero 000 and ask for an ambulance. Staphylococcal scalded skin syndrome johns hopkins medicine. Aug 31, 2016 the symptoms of staphylococcal scalded skin syndrome ssss include blistering of skin on superficial layers due to the exfoliative toxins released from staphylococcus aureus. Staphylococcal scalded skin syndrome in an adult due to methicillinresistant staphylococcus aureus. Bacterial skin infection is a relatively frequent condition in paediatric population. This bacterium produces an exfoliative toxin that causes the outer layers of skin to blister and peel, as if theyve been doused with a hot liquid. Oranje a department of paediatrics and b burn centre, maasstadziekenhuis, c department of. Only 5% of all s aureus strains produce the epidermolytic toxins responsible for ssss. Pediatric annals stevensjohnson syndrome sjs and toxic epidermal necrolysis ten are acute, lifethreatening necrotic skin reactions caused by either medication or, less commonly, infection.
Emergence of a staphylococcus aureus clone resistant to mupirocin and fusidic acid carrying exotoxin genes and causing mainly skin infections. Staphylococcal scalded skin syndrome ssss, also known as ritter disease, and staphylococcal epidermal necrolysis, encompasses a spectrum of superficial blistering skin disorders caused by the exfoliative toxins of some strains of staphylococcus aureus. Alerts and notices synopsis staphylococcal scalded skin syndrome ssss, or ritter disease, is an acute disease caused by epidermolytic toxins released by strains of staphylococcus aureus. Differential diagnosis includes toxic epidermal necrolysis, staphylococcal scalded skin syndrome, epidermolysis bullosa, and stevensjohnson syndrome. Staphylococcal scalded skin syndrome based on the patients classic presentation and exam findings, the physician suspected staphylococcal scalded skin syndrome. The staphylococcal scalded skin syndrome or the ritters disease1 is a staphylococcus aureus skin infection that typically has two periods of incidence. Severe staph skin infections, like staphylococcal scalded skin syndrome ssss, may need to be treated in hospital. Staphylococcus aureus was isolated from ocular, nasal and only perioral lesion cultures but blood cultures were sterile.
Treatment options in ssss include supportive measures, such as. Staphylococcal scalded skin syndrome ssss is a disease that usually affects infants and young children who lack the antibodies to staphylococcus aureus toxins that adults have. Symptoms are widespread bullae with epidermal sloughing. What are the differential diagnoses for staphylococcal. This condition generally affects children mar 29, 2020 ito y, funabashi yoh m, toda k, shimazaki m, nakamura t, morita e. Staphylococcal scalded skin syndrome, impetigo, eczema herpeticum, langerhans cell histiocytosis, infantile hemangiomas, and iga vasculitis all present potential emergencies in pediatric patients in dermatologic settings. Jan 29, 2018 staphylococcal scalded skin syndrome is an exfoliating skin disease which primarily affects children. Foci of infection include the nasopharynx and, less commonly, the umbilicus, urinary tract, a superficial abrasion, conjunctivae, and blood. More efforts are needed to develop novel therapies for staphylococcal scalded skin syndrome. This condition generally affects children symptoms of staphylococcal scalded skin syndrome ssss include blistering of skin on superficial layers due to the exfoliative toxins released from staphylococcus aureus. May 20, 2014 staphylococcal scalded skin syndrome tends to appear abruptly with diffuse erythema and fever. The symptoms of staphylococcal scalded skin syndrome ssss. Oct 21, 2003 staphylococcal scalded skin syndrome ssss is a disease that usually affects infants and young children who lack the antibodies to staphylococcus aureus toxins that adults have.
Treatment is antistaphylococcal antibiotics and local. Staphylococcal scalded skin syndrome in an adult associated with methicillinresistant staphylococcus aureus. Staphylococcal scalded skin syndrome ssss is an illness characterised by red blistering skin that looks like a burn or scald, hence its name staphylococcal scalded skin syndrome. Staphylococcal scalded skin syndrome ssss is a toxinmediated epidermolytic disease that occurs mainly in infants and children. Staphylococcal scalded skin syndrome ssss is the acute, widespread exfoliation of the superficial epidermis at the granular cell layer, 1 mediated by epidermolytic toxins a and b released by staphylococcus aureus bacteria. Stevensjohnson syndrome and toxic epidermal necrolysis. Pediatric dermatology emergencies mdedge dermatology. Staphylococcal scalded skin syndrome in a 4yearold child. The symptoms of staphylococcal scalded skin syndrome ssss include blistering of skin on superficial layers due to the exfoliative toxins released from staphylococcus aureus. Having a high clinical suspicion for staphylococcal scalded skin syndrome, early diagnosistreatment, and following robust hygiene measures. A young girl with a painful rash mdedge family medicine.
Presentation and management of staphylococcal scalded skin. Staphylococcal scalded skin syndrome describes a spectrum of superficial blistering skin disorders caused by the exfoliative toxins of staphylococcus aureus. Recent developments in staphylococcal scalded skin syndrome. A clinical diagnosis of staphylococcal scalded skin syndrome ssss was made based on the diffuse, tender erythroderma and increased erythema of the skin creases. Oftentimes, focal infection of the nasopharynx, conjunctivae, perineum, or umbilicus produces toxins that lead to diffuse fragile bullae. A clinical diagnosis of staphlococcal scalded skin syndrome ssss was made. Staphylococcal scalded skin syndrome in an adult due to methicillineresistant staphylococcus aureus.
Staphylococcal scalded skin syndrome in an extremely. Staphylococcal scalded skin syndrome ssss or acute staphylococcal epidermolysis is an exfoliative skin disease and a toxin mediated staphylococcal infections affecting mostly neonates and adolescents and it is rare in adults 1, 2. Staphylococcal scalded skin syndrome ssss, or ritter disease, is an acute disease caused by epidermolytic toxins released by strains of staphylococcus aureus. Staphylococcal scalded skin syndrome ssss is counted as one of the major skin infections.
Staphylococcal scalded skin syndrome causes, symptoms. The specific toxigenic strains usually belong to phage group 2 types 3a, 3b, 3c, 55, or 71. Both communityassociated and hospitalacquired infections with staphylococcus aureus have increased in the past 20 years, and the rise in incidence has been accompanied by a rise in antibioticresistant strainsin particular, methicillinresistant s aureus mrsa and, more recently, vancomycinresistant strains. A case of abortive staphylococcal scalded skin syndrome. Staphylococcal scalded skin syndrome tends to appear abruptly with diffuse erythema and fever. Dermatologic manifestations of staphylococcal scalded skin. The diagnosis can be confirmed by a skin biopsy specimen. Staphylococcal scalded skin syndrome primarily affects children and can cause serious morbidity. Ssss is caused by the release of two exotoxins epidermolytic toxins a and b from toxigenic strains of the bacteria staphylococcus aureus. Staphylococcal scalded skin syndrome clinicals, diagnosis. Early diagnosis and treatment is imperative to reduce the morbidity. The diagnosis can be confirmed by a skin biopsy specimen, which can.
Staphylococcal scalded skin syndrome bmj case reports. Staphylococcal scalded skin syndrome caused by exfoliative toxin bproducing methicillinresistant staphylococcus aureus letter. Staphylococcalscalded skin syndrome ssss, also known as ritter disease, is a potentially lifethreatening disorder and a pediatric emergency. Staphylococcal scalded skin syndrome ssss, also known as ritter disease, is a bacterial infection of the skin that usually begins in the oral or nasal cavity, umbilicus, or nasopharynx. Staphylococcal scalded skin syndrome ssss occurs most frequently in infants and children up to age 6.
Staphylococcal scalded skin syndrome ssss is a potentially lethal complication of a staphylococcus aureus infection. In this infection, skin surface of large parts of body gets peeled off and looks like burned skin by hot liquid. The diagnosis can be confirmed by a skin biopsy specimen, which can be expedited by frozen section processing, as staphylococcal scalded skin syndrome should be distinguished from life threatening toxic epidermal necrolysis. Staphylococcal scalded skin syndrome ssss, also known as ritter disease, is a bacterial.
Staphylococcal scalded skin syndrome ssss is a serious skin infection caused by the bacterium staphylococcus aureus. Early and accurate identification and management of these entities is critical to avoid shortterm and longterm negative sequelae. To guide pch ed staff with the assessment and management of staphylococcal scalded skin syndrome in children. Recognizing staphylococcal scalded skin syndrome article. Staphylococcal scalded skin syndrome differential diagnosis there are a number of skin disorders which show signs and symptoms similar to that of ssss. It is important to make a diagnosis early, particularly to differentiate it from ten, which has a different management and much greater. Staphylococcal scalded skin syndrome is caused predominantly by phage group 2 staphylococci, particularly strains 71 and 55, which are present at localized sites of infection. Staphylococcal scalded skin syndrome is a potentially lifethreatening disorder caused most often by a phage group ii. Diagnosis in the united kingdom, ssss diagnosis is. After the acute exfoliation of skin surface, erythematous cellulitis occurs. The infection causes peeling skin over large parts of the body.
Ito y, funabashi yoh m, toda k, shimazaki m, nakamura t, morita e. Although dukes identified it as a separate entity, it is thought not to be different from scarlet fever caused by staphylococcal exotoxin after keith powell proposed equating it with the condition currently known as staphylococcal scalded skin syndrome in 1979. Staphylococcal scalded skin syndrome dermatologic disorders. Hence, while diagnosing ssss, it is essential to differentiate it from such similar conditions in order to facilitate the development of an optimum treatment plan.
Staphylococcal scalded skin syndrome is the severe condition caused by exfoliative staphylococcal toxins and is characterized by systemic signs and symptoms and generalized involvement of the skin fig. Ssss is a rare but serious condition that progresses quickly with high fevers and diffuse painful erythema. Staphylococcal scalded skin syndrome is more common in newborns than in adults. In its severe form, the exfoliation can spread to cover the entire body surface area. Staphylococcal scalded skin syndrome wiley online library.
Staphylococcal scalded skin syndrome in a newborn a case. Early diagnosis and treatment is imperative to reduce the morbidity and mortality of this condition. Doudoulakakis a, spiliopoulou i, spyridis n, et al. Staphylococcal scalded skin syndrome is an exfoliating skin disease which primarily affects children. Staphylococcal scalded skin syndrome is an acute epidermolysis caused by a staphylococcal toxin. Use of skin substitute dressings in the treatment of. These toxins cause cleavage of desmoglein 1 complex, a protein in the desmosomes, which hold keratinocytes together in the zona granulosa of the epidermis.
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