Staphylococcal scalded skin syndrome

Background
  • Caused by Staph aureus
  • Most patients <2yr old, nearly all <6 yr old

Clinical Features
Infant with Staphylococcal scalded skin syndrome
  • Rash progresses from erythroderma to extensive areas of exfoliation
  • Systemic symptoms (malaise, fever, irritability, skin tenderness) are common
  • Nikolsky sign (separation of epidermis when pressure is applied) is present
  • No mucous membrane involvement (differentiate from SJS/TENS)

Differential Diagnosis

Erythematous rash

Evaluation[1]
  • PCR for toxin if available
  • CBC - leukocytosis, though normal WBC level oftenly
  • ESR elevation
  • Monitor electrolytes, renal function closely in severe disease
  • Blood cultures variably positive (more often pos in adults)
  • CXR to rule out pneumonia

Management

Antibiotic Options
  • Nafcillin 100mg/kg/d IV in 4 divided doses OR 50mg/kg/d in 4 divided doses PO x7-10d
  • Penicillin G Procaine (300K U/d IM for <30 kg, 600K to 1 million U/d IM for >30 kg)
  • Amoxicillin/Clavulanate 45mg/kg/d PO in 2 divided doses x 7-10d
  • Cefazolin 100mg/kg/d IV in 4 divided doses
  • Cephalexin 40mg/kg/d in 4 divided doses x 7-10d
  • If possible MRSA:
    • Clindamycin 40mg/kg/d IV or PO in 4 divided doses x7-10d
    • Bactrim 10mg/kg/d in 2 divided doses x7-10d
    • Vancomycin 10-15mg/kg/d in 2 divided doses up to 1 gm q12hr

Disposition
  • Transfer to burn center if diffuse
  • Localized infection may discharge home with follow up

See Also

References
  1. Randall WK et al. Staphylococcal Scalded Skin Syndrome Workup. eMedicine. Oct 28, 2015. http://emedicine.medscape.com/article/788199-workup.
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