Staphylococcal Scalded Skin Syndrome Flashcards
What is staphylococcal scalded skin syndrome (SSSS) also known as?
Pemphigus neonatorum or Ritter’s disease
What causes staphylococcal scalded skin syndrome?
Staphylococcus aureus
Who is most commonly affected by staphylococcal scalded skin syndrome?
Neonates and children under 5
When can adults be affected by staphylococcal scalded skin syndrome?
When they are predisposed
What specific group of Staph. Aureus can most commonly cause staphylococcal scalded skin syndrome?
Phage group II
How doe phage group II Staph. Aureus strains cause skin damage?
By releasing epidermolytic toxins
What are the epidermolytic toxins in staphylococcal scalded skin syndrome?
Serine proteases
How do the serine proteases cause widespread damage in staphylococcal scalded skin syndrome?
Spread by circulation from a localised source to cause widespread epidermal damage at distant sites
How do serine proteases cause damage to the epidermis in staphylococcal scalded skin syndrome?
Break down the epidermal cell adhesion molecules to break up the skin
What are the risk factors for staphylococcal scalded skin syndrome?
- 5 years or younger
- Weakened immune system
- CKD or kidney failure
What can often precede staphylococcal scalded skin syndrome?
A prodrome of sore throat or conjunctivitis
What are the initial clinical features of staphylococcal scalded skin syndrome?
- Fever
- Generalised eryhtma
- Skin tenderness
How does staphylococcal scalded skin syndrome develop over the first 48 hours?
There is formation of extremely tender flaccid bullae which are Nikolsky sign positive
What is a positive Nikolsky-sign?
Gentle shearing force on intact skin causes upper epidermis to slip indicating a plane of cleavage in the skin
Where does staphylococcal scalded skin syndrome affect?
Commonly the flexures but larger areas can be involved
What happens to the bullae in staphylococcal scalded skin syndrome?
They enlarge and rupture to reveal a moist erythemaotus base
How is staphylococcal scalded skin syndrome diagnosed?
Clinically
What investigations are required in staphylococcal scalded skin syndrome?
Swabs to confirm bacterial cause and antibiotic sensitivities
What are the differentials for staphylococcal scalded skin syndrome?
- Toxic epidermal necrolysis
- Bullous impetigo
- Toxic shock syndrome
- Staphylococcal scarlet fever
- Pemphigus
What is the first line therapy for staphylococcal scalded skin syndrome?
Topical antibiotics with fusidic acid
What is first line systemic therapy for staphylococcal scalded skin syndrome?
Oral or IV flucloxacillin
Where are patients with staphylococcal scalded skin syndrome usually managed?
In hospital with supportive care
What supportive care measures are used in staphylococcal scalded skin syndrome?
- Fluid and electrolyte maintenance
- Emollient on bare areas
- Analgesia
- Physiotherapy
What are the analgesics used in staphylococcal scalded skin syndrome?
- Paracetamol first line
- Opioid infusion second line
Why is opioid infusion preferred to NSADs in staphylococcal scalded skin syndrome?
Damage skin is prone to bleeding
What is the role of physiotherapy in staphylococcal scalded skin syndrome?
As it affects limb flexures patient may restrict limb movement
What are the potential complications of staphylococcal scalded skin syndrome?
- Dehydration
- Cellulitis
- Sepsis
- Pneumonia
