Dermatologic Manifestations of Staphylococcal Scalded Skin Syndrome Follow-up

  • Author: Jessica H Kim, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 12, 2012
 

Further Inpatient Care

  • Developments in the understanding of the exfoliative toxins of staphylococcal scalded skin syndrome (SSSS) should lead to new and improved diagnostic and therapeutic strategies, including the use of specific antitoxins to prevent exfoliation.[29]
    • Infusing anti-ET antibodies into mice was shown to halt progression of exfoliation in a study performed more than 2 decades ago, but this has never been applied to humans.
    • A recent surge has occurred in reports of methicillin-resistant S aureus strains causing staphylococcal scalded skin syndrome, often with a fatal outcome. These cases emphasize the need to develop alternative treatment strategies before multiple antibiotic resistance becomes a problem.
    • Animal model studies have demonstrated that subinhibitory concentrations of antibiotics such as clindamycin can significantly inhibit toxin production by methicillin-sensitive and methicillin-resistant staphylococcal strains, and antiinflammatory agents such as pentoxifylline can further inhibit activation of the body's inflammatory response to these toxins. Currently, little clinical evidence supports their routine use in the management of staphylococcal scalded skin syndrome.
    • Prevention of progression of staphylococcal scalded skin syndrome by molluscum contagiosum has been observed and indicates possible interference by a viral anticytokine molecule such as interleukin 18 binding protein. The development of drugs based on inflammatory cytokines, including interleukin 18, may be invaluable for halting the progression of severe cases.[30]
Next

Deterrence/Prevention

  • Investigate the possibility of a staphylococcal carrier in the vicinity.
Previous
Next

Complications

  • Cellulitis, sepsis, and pneumonia are possible complications that may occur in children with staphylococcal scalded skin syndrome.
Previous
Next

Prognosis

  • The prognosis of the disease is good in children, and the mortality rate is low if they are treated.
  • In adult cases of staphylococcal scalded skin syndrome, the mortality rate is high despite appropriate antibiotic therapy.
Previous
 
Contributor Information and Disclosures
Author

Jessica H Kim, MD  Clinical Assistant Professor, Division of Dermatology, University of Washington School of Medicine; Dermatology Consultant, Cascade Eye & Skin Centers

Jessica H Kim, MD is a member of the following medical societies: American Academy of Dermatology, American Contact Dermatitis Society, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, National Psoriasis Foundation, Washington State Medical Association, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Paul Benson, MD  Chief, Program Director, Dermatology Service, Walter Reed Army Medical Center; Associate Professor, Department of Dermatology, Uniformed Services University of the Health Sciences at Bethesda

Paul Benson, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard Sperling, MD  Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences

Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Ladhani S, Robbie S, Garratt RC, Chapple DS, Joannou CL, Evans RW. Development and evaluation of detection systems for staphylococcal exfoliative toxin A responsible for scalded-skin syndrome. J Clin Microbiol. Jun 2001;39(6):2050-4. [Medline].

  2. Amagai M. Desmoglein as a target in autoimmunity and infection. J Am Acad Dermatol. Feb 2003;48(2):244-52. [Medline].

  3. Anzai H, Stanley JR, Amagai M. Production of low titers of anti-desmoglein 1 IgG autoantibodies in some patients with staphylococcal scalded skin syndrome. J Invest Dermatol. Sep 2006;126(9):2139-41. [Medline].

  4. Hanakawa Y, Stanley JR. Mechanisms of blister formation by staphylococcal toxins. J Biochem (Tokyo). Dec 2004;136(6):747-50. [Medline].

  5. Yamasaki O, Tristan A, Yamaguchi T, et al. Distribution of the exfoliative toxin D gene in clinical Staphylococcus aureus isolates in France. Clin Microbiol Infect. Jun 2006;12(6):585-8. [Medline].

  6. Yamasaki O, Yamaguchi T, Sugai M, et al. Clinical manifestations of staphylococcal scalded-skin syndrome depend on serotypes of exfoliative toxins. J Clin Microbiol. Apr 2005;43(4):1890-3. [Medline].

  7. Ugburo AO, Temiye EO, Ilombu CA. A 12-year retrospective study of non-burn skin loss (burn-like syndromes) at a tertiary burn unit in a developing country. Burns. 2008;34:637-643. [Medline].

  8. Hayward A, Knott F, Petersen I, et al. Increasing hospitalizations and general practice prescriptions for community-onset staphylococcal disease, England. Emer Infect Dis. May 2008;14(5):720-6. [Medline].

  9. Patel GK, Finlay AY. Staphylococcal scalded skin syndrome: diagnosis and management. Am J Clin Dermatol. 2003;4(3):165-75. [Medline].

  10. Rydzewska-Rosolowska A, Brzosko S, Borawski J, Mysliwiec M. Staphylococcal scalded skin syndrome in the course of lupus nephritis. Nephrology (Carlton). Jun 2008;13(3):265-6. [Medline].

  11. Brewer JD, Hundley MD, Meves A, Hargreaves J, McEvoy MT, Pittelkow MR. Staphylococcal scalded skin syndrome and toxic shock syndrome after tooth extraction. J Am Acad Dermatol. Aug 2008;59(2):342-6. [Medline].

  12. Toyota E, Mitake H, Mikami Y, et al. A case of TSS complicated with SSSS in an adult with liver cirrhosis (in Japanese). Kansenshogaku Zasshi. 1994;68:1421-7.

  13. Cribier B, Piemont Y, Grosshans E. Staphylococcal scalded skin syndrome in adults. A clinical review illustrated with a new case. J Am Acad Dermatol. Feb 1994;30(2 Pt 2):319-24. [Medline].

  14. Dobson CM, King CM. Adult staphylococcal scalded skin syndrome: histological pitfalls and new diagnostic perspectives. Br J Dermatol. May 2003;148(5):1068-9. [Medline].

  15. Hardwick N, Parry CM, Sharpe GR. Staphylococcal scalded skin syndrome in an adult. Influence of immune and renal factors. Br J Dermatol. Mar 1995;132(3):468-71. [Medline].

  16. Mockenhaupt M, Idzko M, Grosber M, Schopf E, Norgauer J. Epidemiology of staphylococcal scalded skin syndrome in Germany. J Invest Dermatol. Apr 2005;124(4):700-3. [Medline].

  17. Adhisivam B, Mahadevan S. Abscess of the nasal septum with staphylococcal scalded skin syndrome. Indian Pediatr. Apr 2006;43(4):372-3. [Medline].

  18. Haveman LM, Fleer A, de Vries LS, Gerards LJ. Congenital staphylococcal scalded skin syndrome in a premature infant. Acta Paediatr. Dec 2004;93(12):1661-2. [Medline].

  19. Kapoor V, Travadi J, Braye S. Staphylococcal scalded skin syndrome in an extremely premature neonate: a case report with a brief review of literature. J Paediatr Child Health. Jun 2008;44(6):374-6. [Medline].

  20. Takagi Y, Futamura S, Asada Y. Action site of exfoliative toxin on keratinocyte. J Invest Dermatol. 1990;94:582.

  21. Stanley JR, Amagai M. Pemphigus, bullous impetigo, and the staphylococcal scalded-skin syndrome. N Engl J Med. Oct 26 2006;355(17):1800-10. [Medline].

  22. Hansen RC. Staphylococcal scalded skin syndrome, toxic shock syndrome, and Kawasaki disease. Pediatr Clin North Am. Jun 1983;30(3):533-44. [Medline].

  23. Tenenbaum T, Hoehn T, Hadzik B, et al. Exchange transfusion in a preterm infant with hyperbilirubinemia, staphylococcal scalded skin syndrome (SSSS) and sepsis. Eur J Pediatr. Jul 2007;166(7):733-5. [Medline].

  24. Neylon O, O'Connell NH, Slevin B, Powell J, Monahan R, Boyle L, et al. Neonatal staphylococcal scalded skin syndrome: clinical and outbreak containment review. Eur J Pediatr. Dec 2010;169(12):1503-9. [Medline].

  25. El Helali N, Carbonne A, Naas T, et al. Nosocomial outbreak of staphylococcal scalded skin syndrome in neonates: epidemiological investigation and control. J Hosp Infect. Oct 2005;61(2):130-8. [Medline].

  26. Blyth M, Estela C, Young AE. Severe staphylococcal scalded skin syndrome in children. Burns. Feb 2008;34(1):98-103. [Medline].

  27. Ramos-e-Silva M, Pereira AL. Life-threatening eruptions due to infectious agents. Clin Dermatol. Mar-Apr 2005;23(2):148-56. [Medline].

  28. Reddy K, Kogan S, Glick SA. Procedures and drugs in pediatric dermatology: iatrogenic risks and situations of concern. Clin Dermatol. Nov-Dec 2011;29(6):633-43. [Medline].

  29. Ladhani S. Recent developments in staphylococcal scalded skin syndrome. Clin Microbiol Infect. Jun 2001;7(6):301-7. [Medline].

  30. Kato Z, Tsubouchi K, Kondo N. Molluscum contagiosum prevents progression of staphylococcal scalded skin syndrome. Eur J Pediatr. Dec 2005;164(12):768-9. [Medline].

  31. Blume JE, Levine EG, Heymann WR. Staphylococcal scalded skin syndrome. In: Bolognia JL, Jorizzo J, Rapini R, eds. Dermatology. Vol 1. London, England: Harcourt; 2003:1119.

  32. Fritsch PO, Ruiz-Maldonado R. Stevens-Johnson syndrome/Toxic epidermal necrolysis. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, Fitzpatrick TB, eds. Fitzpatrick's Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999:644-54.

  33. Gemmell CG. Staphylococcal scalded skin syndrome. J Med Microbiol. Nov 1995;43(5):318-27. [Medline].

  34. Ladhani S, Joannou CL. Difficulties in diagnosis and management of the staphylococcal scalded skin syndrome. Pediatr Infect Dis J. Sep 2000;19(9):819-21. [Medline].

  35. Resnick SD, Elias PM. Staphylococcal scalded-skin syndrome. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, Fitzpatrick TB, eds. Fitzpatrick's Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999:2207-12.

  36. Sladden MJ, Mortimer NJ, Elston G, Newey M, Harman KE. Staphylococcal scalded skin syndrome as a complication of septic arthritis. Clin Exp Dermatol. Nov 2007;32(6):754-5. [Medline].

  37. Wikas SM, Tomecki KJ. Staphylococcal scalded-skin syndrome. The Cleveland Clinic experience. Cleve Clin Q. 1983;50(2):141-3. [Medline].

  38. Williams RE, MacKie RM. The staphylococci. Importance of their control in the management of skin disease. Dermatol Clin. Jan 1993;11(1):201-6. [Medline].

 
Previous
Next
 
An infant with characteristic coloring in the skin that looks as though the child has been scalded.
Staphylococcal scalded skin syndrome in an adult.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.