Staphylococcal scalded skin syndrome

Question 1

Staphylococcal scalded skin syndrome is a rare, severe, superficial blistering skin disorder which is characterised by the detachment of the outermost skin layer (epidermis). How does this typically present?

1 - erythematous and scaly skin
2 - large solid plaques
3 - widespread flaccid bulla (fluid filled lesion >0.5cm)
4 - infected cystic lesion on the face and hands

Answer 1

3 - widespread flaccid bulla (fluid filled lesion >0.5cm)

• caused by the exfoliative toxin produced by phase group II strains of Staphylococcus aureus

Question 2

What is the mortality rate of Staphylococcal scalded skin syndrome in children?

1 - 1-5%
2 - 10-15%
3 - 25-40%
4 - 50%

Answer 2

1 - 1-5%

• adults = 50% due to comorbidities

Question 3

Staphylococcal scalded skin syndrome is a rare, severe, superficial blistering skin disorder which is characterised by the detachment of the outermost skin layer (epidermis). Does this typically affect adults or children?

Answer 3

• children
• can be seen in adults, but is rare, but if adults are affected the mortality is high

Question 4

Which of the following is NOT a risk factor for Staphylococcal scalded skin syndrome?

1 - Broken skin
2 - Immune suppression
3 - Pre-existing skin condition - atopic dermatitis etc
4 - Born via a C-section
5 - Chronic swelling of legs or arms
6 - Prolong use of systemic steroid

Answer 4

4 - Born via a C-section

Question 5

Diagnosis of Staphylococcal scalded skin syndrome is typically a clinical diagnosis. However, all of the following can be useful, EXCEPT which one?

1 - LFTs
2 - U&Es (systemic inflammation may cause AKI)
3 - FBC (WBC may be raised)
4 - CRP, ESR and creatine kinase
5 - swab to identify pathogen

Answer 5

1 - LFTs
- may be done as liver can be affected, but least useful from the list

Question 6

Most bacterial skin infections are treated in the same manner. Which of the following would be used in a mild bacterial skin infection?

1 - Oral antibiotics
2 - Intravenous antibiotics
3 - Topical antibiotics
4 - Penicillin allergy

Answer 6

3 - Topical antibiotics

• fusidic acid or mupirocin

Question 7

Most bacterial skin infections are treated in the same manner. Which 2 of the following would be used in a moderate bacterial skin infection?

1 - Oral antibiotics
2 - Intravenous antibiotics
3 - Topical antibiotics
4 - Penicillin allergy

MRSA

PVL

Answer 7

1 - Oral antibiotics
2 - Intravenous antibiotics

• most common antibiotics used are
  flucloxacillin
• penicillin allergies should be given erythromycin

Question 8

Which 2 of the following should be considered if a patient has recurrent skin infection or a skin infection is resistant to antibiotics?

1 - MRSA
2 - Type 1 diabetes
3 - PVL (panton valentine leukocidin) staphylococcus aureus
4 - Sepsis

Answer 8

1 - MRSA
3 - PVL (panton valentine leukocidin) staphylococcus aureus

Question 9

What is the main distinguishing factor between Staphylococcal scalded skin syndrome (SSSS) and steven johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)?

1 - SSSS only occurs in children
2 - SSSS does not affect mucosal membranes
3 - SSSS affects just lower limbs
4 - SSSS is caused by blood trasnfusion

Answer 9

2 - SSSS does not affect mucosal membranes

Question 10

Staphylococcal scalded skin syndrome is a severe systemic reaction affecting the skin. It typically presents with maculopapular but can develop into vesicles or bullae. In extreme cases it can result in Nikolsky positive, what is this?

1 - extensive erythamatous skin changes
2 - extensive nodules appearing all over the torso
3 - skin becomes red, fluid collects underneath, skin is rubbed off leaving erythamtous under layer
4 - all of the above

Answer 10

3 - skin becomes red, fluid collects underneath, skin is rubbed off leaving erythamtous under layer