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Description

• A spectrum of generalized exfoliative skin eruptions, which resemble scalding injuries but are caused by an epidermolytic toxin produced by certain strains of Staphylococcus aureus.
• Known as Ritter disease or pemphigus neonatorum in neonates
• Spectrum of disease includes:
  • Bullous impetigo: Characterized by discrete, flaccid bullae containing clear or cloudy yellow fluid localized to the site of staphylococcal infection
  • Staphylococcal scarlet fever: A mild generalized scarlatiniform eruption with exfoliation, but without the strawberry tongue and palatal enanthem of streptococcal scarlet fever. Evidence based on toxin production now suggests that staphylococcal scarlet fever often represents an abortive form of toxic shock syndrome (TSS).
  • Classic staphylococcal scalded skin syndrome (SSSS): Characterized by abrupt onset of fever, irritability, and diffuse, blanchable erythema in association with marked skin tenderness in which toxin circulates throughout the body, causing blisters at and distant to the site of infection
• Pitfalls:
  • Differentiation from streptococcal disease with need for penicillinase-resistant antibiotic therapy (e.g., nafcillin)
  • A methicillin-resistant strain of S. aureus has been reported to cause SSSS.
  • Adhesive occlusive dressings used to apply topical local anesthetic prior to venipuncture have been shown to cause injury and discomfort in areas previously free of blistering in patients with SSSS.
  • Diagnosis should be made clinically and should not be delayed several days while waiting for the results of cultures or other diagnostic tests, which are largely confirmatory.

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