dermatologic disorders
Staphylococcal Scalded Skin Syndrome
Introduction
Staphylococcal scalded skin syndrome is an acute epidermolysis caused by a staphylococcal toxin. Infants and children are most susceptible. Symptoms are widespread bullae with epidermal sloughing. Diagnosis is by examination and sometimes biopsy. Treatment is antistaphylococcal antibiotics and local care. Prognosis is excellent with timely treatment. (See also Overview of Bacterial Skin Infections .) Staphylococcal scalded skin syndrome almost always affects children<6 years (especially infants); it rarely occurs in older adults unless they have renal failure or are immunocompromised. Epidemics may occur in nurseries, presumably transmitted by the hands of personnel who are in contact with an infected infant or who are nasal carriers ofStaphylococcus aureus. Sporadic cases also occur. Staphylococcal scalded skin syndrome is caused by group II coagulase-positive staphylococci, usually phage types 55 and 71, which elaborate exfoliatin (also called epidermolysin), a toxin that splits the upper part of the epidermis just beneath the granular cell layer by targeting desmoglein-1 (see Staphylococcal Infections ). The primary infection often begins during the first few days of life in the umbilical stump or diaper area; in older children, the face is the typical site. Toxin produced in these areas enters the circulation and affects the entire skin. 