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Staphylococcal scalded skin syndrome in Infant/Neonate
Other Resources UpToDate PubMed

Staphylococcal scalded skin syndrome in Infant/Neonate

Contributors: Lauren Ko, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Staphylococcal scalded skin syndrome (SSSS), or Ritter disease, is an acute disease caused by epidermolytic toxins released by strains of Staphylococcus aureus. Newborns are particularly susceptible to these exfoliative toxins. Oftentimes, focal infection of the nasopharynx, conjunctivae, perineum, or umbilicus produces toxins that lead to diffuse fragile bullae, which are often no longer intact at the time of presentation. However, any systemic or cutaneous infection with epidermolytic toxin-producing S. aureus may induce SSSS. Infants are believed to have increased susceptibility to SSSS due to lack of neutralizing antibodies and decreased renal capacity for toxin excretion.

In the newborn, presentation generally occurs between 3-7 days of life, with only one reported case of congenital SSSS. Symptoms occur acutely, with sudden onset of fever, irritability, cutaneous tenderness, and characteristic cutaneous eruption. Symptoms of SSSS can occur in conjunction with bullous impetigo. Full recovery occurs in most cases. Sepsis (with multisystemic involvement) and fluid and electrolyte abnormalities are possible.

Codes

ICD10CM:
L00 – Staphylococcal scalded skin syndrome

SNOMEDCT:
200946001 – Staphylococcal scalded skin syndrome

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Bullous impetigo  – Localized with honey-colored crusted plaques, bacteria present in bullae.
  • Neonatal candidiasis
  • Exanthematous drug eruption
  • Erythroderma
  • Collodion baby
  • Conradi disease
  • Leiner disease
  • Lamellar ichthyosis
  • Keratitis-ichthyosis-deafness syndrome (KID syndrome)
  • Netherton syndrome
  • Bullous congenital ichthyosiform erythroderma – Present at birth and persists despite appropriate antibiotics.
  • Toxic epidermal necrolysis (TEN) – Nikolsky's sign only in erythematous areas and mucous membrane involvement, drug induced, high fevers, skin tenderness, mucosal erosions, and skin detachment about 1-3 weeks after the inciting medication is started.
  • Ichthyosis bullosa of Siemens (see Bullous congenital ichthyosiform erythroderma) – Present at birth and persists despite appropriate antibiotics.
  • Epidermolysis bullosa simplex
  • Early congenital syphilis
  • Boric acid toxicity
  • Methylmalonic acidemia
  • Toxic shock syndrome – High fevers and severe systemic symptoms including vomiting and diarrhea; hypotension quickly ensues; diffuse scarlatiniform exanthem that starts on the trunk (in contrast to face in SSSS).
  • Drug-induced hypersensitivity syndrome (DRESS)
  • Stevens-Johnson syndrome – Drug induced, high fevers, skin tenderness, mucosal erosions, and skin detachment about 1-3 weeks after the inciting medication is started.
  • Scarlet fever – 1 mm erythematous papules, always elevated WBC with left shift, eosinophilia in up to 20% of patients.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:06/08/2017
Last Updated:05/05/2021
Copyright © 2024 VisualDx®. All rights reserved.
Staphylococcal scalded skin syndrome in Infant/Neonate
A medical illustration showing key findings of Staphylococcal scalded skin syndrome : Bullae, Desquamation, Erythroderma, Painful skin lesions, Rhinorrhea, Widespread distribution, Conjunctival injection
Clinical image of Staphylococcal scalded skin syndrome - imageId=2140314. Click to open in gallery.  caption: 'Diffuse bright red erythema with large areas of overlying peeling on the trunk and legs.'
Diffuse bright red erythema with large areas of overlying peeling on the trunk and legs.
Copyright © 2024 VisualDx®. All rights reserved.