dermatologic disorders
Staphylococcal Scalded Skin Syndrome
Symptoms and Signs of Staphylococcal Scalded Skin Syndrome
When a localized area of infection can be found (eg, impetigo), the initial lesion is usually superficial and crusted. Within 24 hours, the surrounding skin becomes painful and erythematous, changes that quickly spread to other areas. The skin may be exquisitely tender and have a wrinkled tissue paper–like consistency. Large, flaccid blisters arise on the erythematous skin and quickly break to produce erosions. Blisters are frequently present in areas of friction, such as intertriginous areas, buttocks, hands, and feet. Intact blisters extend laterally with gentle pressure (Nikolsky sign). The epidermis may peel easily, often in large sheets. Widespread desquamation occurs within 36 to 72 hours, and patients may become very ill with systemic manifestations (eg, malaise, chills, fever). Desquamated areas appear scalded. Loss of the protective skin barrier can lead to Sepsis and Septic Shock and to fluid and electrolyte imbalance. Staphylococcal scalded skin syndrome is epidermolysis caused by a staphylococcal toxin. Findings include erythema with overlying desquamation in sheets, particularly in the intertriginous area of the groin and axillae. Often there is also perioral peeling. Image courtesy of Thomas Habif, MD. This photo shows the leg of a patient with all three stages of the infection: erythema (at center), bullae (left), and desquamation (right). SCIENCE PHOTO LIBRARY This image shows staphylococcal scalded skin syndrome with superficial skin blistering caused byStaphylococcus aureusinfection. This syndrome is rare in adults but can occur in people who are immunocompromised or who have renal failure or another chronic disease. DermPics/SCIENCE PHOTO LIBRARY 