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Staphylococcal Scalded Skin Syndrome - Causes, Symptoms and Treatments

A severe skin disorder, staphylococcal scalded skin syndrome (SSSS) is marked by epidermal erythema, peeling, and superficial necrosis that give the skin a scalded appearance. SSSS is most prevalent in infants ages 1 to 3 months but may develop in children; it's rare in adults.

This disease follows a consistent pattern of progression, and most patients recover fully. Mortality is 2% to 3%, with death usually resulting from complications of fluid and electrolyte loss, sepsis, and involvement of other body systems.

Causes of Staphylococcal Scalded Skin Syndrome:

The causative microbe in SSSS is Group 2 Staphylococcus aureus, primarily phage type 71. Predisposing factors may include impaired immunity and renal insufficiency - present to some extent in the normal neonate because of immature development of these systems.

Signs and symptoms of Staphylococcal Scalded Skin Syndrome:

SSSS can often be traced to a prodromal upper respiratory tract infection, possibly with concomitant purulent conjunctivitis. Cutaneous changes progress through three stages.

1. Erythema: In the first stage, erythema becomes visible, usually around the mouth and other orifices, as well as body fold areas, and may spread in widening circles over the entire body surface. The skin becomes tender; Nikolsky's sign (sloughing of the skin when friction is applied) may appear.

2. Exfoliation: About 24 to 48 hours later, exfoliation occurs. In the more common, localized form of this disease, superficial erosions and minimal crusting develop, generally around body orifices, and may spread to exposed areas of the skin. In the more severe forms of this disease, large, flaccid bullae erupt and may spread to cover extensive areas of the body. These bullae eventually rupture, revealing denuded skin.

3. Desquamation: In this final stage, affected areas dry up and powdery scales form. Normal skin replaces these scales in 5 to 7 days.

Diagnosis of Staphylococcal Scalded Skin Syndrome:

Careful observation of the three-stage progression of this disease allows diagnosis. Results of exfoliative cytology and a biopsy aid in the differential diagnosis, ruling out erythema multiforme and drug-induced toxic epidermal necrolysis, both of which are similar to SSSS.

A blood culture is necessary to rule out sepsis.

Treatment of Staphylococcal Scalded Skin Syndrome:

Systemic antibiotics, usually penicillinase­resistant penicillin, treat the underlying infection. Replacement measures maintain fluid and electrolyte balance.

Special considerations of Staphylococcal Scalded Skin Syndrome:

1. Provide special care for the neonate if required, including placement in a warming infant incubator to maintain body temperature and provide isolation.

2. Carefully monitor intake and output to assess fluid and electrolyte balance. In severe cases, I.V. fluid replacement may be necessary.

3. Check vital signs. Be especially alert for a sudden rise in temperature, indicating sepsis, which requires prompt, aggressive treatment.

4. Maintain skin integrity. Remember to use strict aseptic technique to preclude secondary infection, especially during the exfoliative stage, because of open lesions.

5. To prevent friction and sloughing of the patient's skin, leave affected areas uncovered or loosely covered. Place cotton between fingers and toes that are severely affected to prevent webbing.

6. Administer warm baths and soaks during the recovery period. Gently debride exfoliated areas.

7. Reassure parents that complications are rare and residual scars are unlikely.

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