Staphylococcal Scalded Skin Syndrome Flashcards

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1
Q

What is staphylococcal scalded skin syndrome (SSSS) also known as?

A

Pemphigus neonatorum or Ritter’s disease

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2
Q

What causes staphylococcal scalded skin syndrome?

A

Staphylococcus aureus

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3
Q

Who is most commonly affected by staphylococcal scalded skin syndrome?

A

Neonates and children under 5

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4
Q

When can adults be affected by staphylococcal scalded skin syndrome?

A

When they are predisposed

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5
Q

What specific group of Staph. Aureus can most commonly cause staphylococcal scalded skin syndrome?

A

Phage group II

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6
Q

How doe phage group II Staph. Aureus strains cause skin damage?

A

By releasing epidermolytic toxins

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7
Q

What are the epidermolytic toxins in staphylococcal scalded skin syndrome?

A

Serine proteases

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8
Q

How do the serine proteases cause widespread damage in staphylococcal scalded skin syndrome?

A

Spread by circulation from a localised source to cause widespread epidermal damage at distant sites

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9
Q

How do serine proteases cause damage to the epidermis in staphylococcal scalded skin syndrome?

A

Break down the epidermal cell adhesion molecules to break up the skin

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10
Q

What are the risk factors for staphylococcal scalded skin syndrome?

A
  • 5 years or younger
  • Weakened immune system
  • CKD or kidney failure
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11
Q

What can often precede staphylococcal scalded skin syndrome?

A

A prodrome of sore throat or conjunctivitis

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12
Q

What are the initial clinical features of staphylococcal scalded skin syndrome?

A
  • Fever
  • Generalised eryhtma
  • Skin tenderness
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13
Q

How does staphylococcal scalded skin syndrome develop over the first 48 hours?

A

There is formation of extremely tender flaccid bullae which are Nikolsky sign positive

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14
Q

What is a positive Nikolsky-sign?

A

Gentle shearing force on intact skin causes upper epidermis to slip indicating a plane of cleavage in the skin

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15
Q

Where does staphylococcal scalded skin syndrome affect?

A

Commonly the flexures but larger areas can be involved

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16
Q

What happens to the bullae in staphylococcal scalded skin syndrome?

A

They enlarge and rupture to reveal a moist erythemaotus base

17
Q

How is staphylococcal scalded skin syndrome diagnosed?

A

Clinically

18
Q

What investigations are required in staphylococcal scalded skin syndrome?

A

Swabs to confirm bacterial cause and antibiotic sensitivities

19
Q

What are the differentials for staphylococcal scalded skin syndrome?

A
  • Toxic epidermal necrolysis
  • Bullous impetigo
  • Toxic shock syndrome
  • Staphylococcal scarlet fever
  • Pemphigus
20
Q

What is the first line therapy for staphylococcal scalded skin syndrome?

A

Topical antibiotics with fusidic acid

21
Q

What is first line systemic therapy for staphylococcal scalded skin syndrome?

A

Oral or IV flucloxacillin

22
Q

Where are patients with staphylococcal scalded skin syndrome usually managed?

A

In hospital with supportive care

23
Q

What supportive care measures are used in staphylococcal scalded skin syndrome?

A
  • Fluid and electrolyte maintenance
  • Emollient on bare areas
  • Analgesia
  • Physiotherapy
24
Q

What are the analgesics used in staphylococcal scalded skin syndrome?

A
  • Paracetamol first line

- Opioid infusion second line

25
Q

Why is opioid infusion preferred to NSADs in staphylococcal scalded skin syndrome?

A

Damage skin is prone to bleeding

26
Q

What is the role of physiotherapy in staphylococcal scalded skin syndrome?

A

As it affects limb flexures patient may restrict limb movement

27
Q

What are the potential complications of staphylococcal scalded skin syndrome?

A
  • Dehydration
  • Cellulitis
  • Sepsis
  • Pneumonia