Staph scalded skin syndrome Flashcards
What is Staphylococcal scalded skin syndrome (SSSS)
Rare, severe, superficial blistering skin disorder, characterised by the detachment of the epidermis.
Cause of SSSS?
Exotoxin release from specific strains of staphylococcus aureus bacteria
Epidemiology of SSSS?
Predominantly seen in children younger than 5y/o
V rare to see it in pts older- if so due to immunosuppression
Why do young children get SSSS?
Immature:
-Immune system- lack of protective antibodies to exotoxins
- Renal clearance system- reduced clearance of toxins
Pathophysiology of SSSS?
1) Localised infectious caused by toxigenic Staph. aureus ( usually starts are ears, eyes or throat)
2) 2 exotoxins released by S.aureus
3) Bind to specific desmosome in skin which is responsible for maintaining cell- cell adherence.
4) This desmosome gets broken down–> cells become unstuck–> blistering
Clinical features of SSSS?
Non- specific sx: irritability, lethargy and fever
24-48hrs later, widespread, painful, red rash (starts on face and flexural regions and then spreads) followed by large, fragile and painful bullae ( areas of friction and centre of face and body orifices), which can rupture easily.
Bullae rupture easily causing top layer of skin to peel off easily often in large sheets–> exposing underlying moist, reddish tissue–> burnt appearance appearance.
Gentle rubbing of skin causes exfoliation of outer layer of skin (Nikolsky sign is positive)
Complications of SSSS?
Scarring
Loss of bodily fluids–> dehydration and electrolyte imbalance
Hypothermia
Secondary infections e.g. sepsis, cellulits, and pneumonia
Renal failure
Prognosis of SSSS?
Most children have full recovery within 2 weeks unless complications occur.
Adults have high mortality rate (50-60%) but due to the condition that has predisposed them to get this, rather than SSSS itself
Investigations for SSSS?
Skin swabs- may still be S.aureus negative as the condition is toxin mediated
Blood cultures- if sepsis is a concern
Tzanck smear
Skin biopsy to exclude other causes of blistering
NOTE:
The Tzanck smear is mainly used in an acute setting to rapidly detect a herpes infection or to distinguish Stevens- Johnson syndrome / toxic epidermal necrolysis (SJS/TEN) from staphylococcal scalded skin syndrome. However, it can be used to diagnose a variety cutaneous infections and blistering diseases.
What does a skin biopsy in SSSS show?
Non- inflammatory intra-epidermal splitting at the granular layer
DDx for SSSS?
SJS/TEN
Bullous impetigo
Drug sensitivity reaction
Viral exanthem
Thermal Burns
Treatment for SSSS?
IV abx: flucloxacillin, or clarithromycin (if penicillin-allergy)
Supportive:
-pain relief
-maintaining fluid + electrolyte balance e.g. IV fluids
- Skincare: gentle skin washing with soap subs (ODS), application of greasy emollients and burn dressings may be required.
