Staphylococcal scalded skin syndrome: Viva

Branching clinical structured oral on a febrile infant with tender erythema and sheet-like desquamation: recognising staphylococcal scalded skin syndrome, the desmoglein 1 mechanism and mucosal sparing, the distinction from Stevens-Johnson syndrome, and the antibiotic choice with clindamycin for toxin suppression.

branching clinical structured oral2 min readVerification in progress

Prompt

A 10-month-old boy presents to the emergency department with irritability, fever at 38.5 degrees C, and redness around his mouth and in his axillary folds. Over the last few hours the skin of his trunk and flexures has begun to peel off in sheets when handled, and the surrounding skin shears away on light stroking. His oral, conjunctival, and genital mucosae are intact. The examiner asks for your structured approach.

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]

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References3Show ledger

[1]Ladhani S Staphylococcal scalded skin syndrome. Arch Dis Child, 1998.PMID 9534685
[2]Ladhani S Clinical, microbial, and biochemical aspects of the exfoliative toxins causing staphylococcal scalded-skin syndrome. Clin Microbiol Rev, 1999.PMID 10194458
[3]Handler MZ Staphylococcal scalded skin syndrome: diagnosis and management in children and adults. J Eur Acad Dermatol Venereol, 2014.PMID 24841497