Staphylococcal scalded skin syndrome: Viva

Branch 1: Recognising the diagnosis and the cardinal clue

The candidate should recognise this infant as having generalised staphylococcal scalded skin syndrome, with the prodrome of irritability and fever, the scarlet erythema around the mouth and flexures, the flaccid bullae, and the sheet-like peeling with a positive Nikolsky sign. The diagnosis is clinical, and the picture is characteristic enough that laboratory confirmation is not required to begin treatment. ^[1]

The candidate should then state explicitly the feature that separates this disease from Stevens-Johnson syndrome and toxic epidermal necrolysis, which is the sparing of the mucous membranes. The oral, conjunctival, and genital surfaces are intact in SSSS, and their involvement would shift the diagnosis toward a drug-induced reaction. Documenting the mucosae at every assessment keeps this distinction clear and directs the child to the correct pathway. ^[3]