What is Staphylococcal Scalded Skin Syndrome?

Staphylococcal skin scald-like syndrome (SSSS) was once called neonatal exfoliative dermatitis, Staphylococcus aureus-type toxic epidermolysis, bacterial toxic epidermal necrolysis, and Ritter's disease. This disease is a severe acute generalized exfoliative pustulosis occurring in newborns. It is characterized by the occurrence of flaccid scalp-like bullae and large epidermal exfoliation based on generalized erythema. Most of them occur in infants. , Occasionally seen in adults.

Basic Information

nickname

Exfoliative dermatitis of newborn, Staphylococcus aureus type toxic epidermolysis

English name

staphylococcalscaldedskinsyn-drome

Visiting department

dermatology

Multiple groups

baby

Common symptoms

Impetigo, scalded bullae, large exfoliation

Causes of staphylococcal scalded skin syndrome

The disease is mainly a severe skin infection caused by coagulase-positive phage II group 71 Staphylococcus aureus. This type of staphylococcus can produce epidermolytic toxins and cause skin damage. It has now been found that certain staphylococci from group or group can also produce epidermal loosening toxins, which increase in serum levels and cause skin damage and exfoliation. Staphylococcal skin burn-like syndromes that occur in adults are more common in people with nephritis, uremia, immunodeficiency, or severe staphylococcal sepsis.

Clinical manifestations of staphylococcal scalded skin syndrome

The disease mostly occurs in infants 1 to 5 weeks after birth and occasionally in adults. Sudden onset, erythema occurred around the mouth or around the eyelids, and then quickly spread to the trunk and proximal limbs, and even spread to the whole body, with obvious tenderness at the lesion. On the basis of erythema, flaccid bullae occurs, exudation crusts appear around the mouth and around the eyelids within 1 to 2 days, and large areas of the crusts may fall off, leaving radial clefts around the mouth. The epidermis of other parts was superficially wrinkled and rubbed a little hard, that is, a large area of the epidermis was peeled off, exposing the bright red edema and erosion surface, which is positive for Nissl sign, similar to burns. At the edge of the erosion, the epidermis is loose and curly, and the skin of the hands and feet can be exfoliated like gloves or socks. Later, the exfoliation gradually changes from bright red to purplish red, dark red, no longer exfoliated, bran-like desquamation, and heal in 7 to 14 days. . The oral cavity, nasal mucosa, and eye conjunctiva can be affected, with stomatitis, rhinitis, and corneal ulcers. Patients often have systemic symptoms such as fever, anorexia, vomiting, and diarrhea. Some died of secondary bronchial pneumonia, sepsis, abscess or gangrene, etc., which often occur in infants and young children.

Diagnosis of staphylococcal scalded skin syndrome

According to the clinical manifestations of infants born at 1 to 5 weeks, the onset is rapid, flaccid bullae, large epidermal exfoliation, positive Nissl sign and other clinical manifestations appear on the basis of erythema, combined with bacterial culture, the diagnosis is not difficult. If necessary, ET-A, ET-B, and ET-D can be tested.

Differential diagnosis of staphylococcal scalded skin syndrome

This disease needs to be distinguished from neonatal impetigo, desquamative erythroderma, and non-staphylococcal TEN.

Treatment of staphylococcal scalded skin syndrome

1. Pay attention to the cleanliness of the baby. The diapers should be clean. No medical staff or family members with purulent skin diseases should contact the newborn.

2. Strengthen nursing and keep warm. Pay attention to oral and eye care.

3. A sufficient amount of effective antibiotics should be used in the early stage to clear the Staphylococcus aureus infection in the body and stop the production of bacterial toxins. Antibiotic susceptibility tests are performed to select appropriate antibiotics.

4. Pay attention to water and electrolyte balance, supplement nutrition, and strengthen supportive therapies, such as blood transfusion.

5. There are different opinions on the application of hormones, and it is forbidden to use hormones alone. Because hormones can cause immunosuppression, it is not only useless but harmful. However, some people have suggested that the early application of antibiotics can be combined with hormones to reduce the toxin effect of bacteria.

6. Non-irritating fungicides should be used topically, such as 0.5% to 1% neomycin emulsion for external use. The bullae capsule is best removed, and then wet-applied with a solution of 1: 10000 to 1: 5000 potassium permanganate or 1: 2000 Berberine solution.