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'''For patient information, click [[Staphylococcal scalded skin syndrome (patient information)|here]]'''
'''For patient information, click [[Staphylococcal scalded skin syndrome (patient information)|here]]'''


{{SI}}
{{SSSS}}
{{CMG}}
{{CMG}}


{{SK}} Ritter's disease; pemphigus neonatorum; localized bullous impetigo; SSSS.
{{SK}} Ritter's disease; pemphigus neonatorum; localized bullous impetigo; SSSS.
==Overview==
'''Staphylococcal scalded skin syndrome''' is a [[dermatology|dermatological]] condition caused by ''[[Staphylococcus aureus]]''.


==Pathophysiology==
==[[Staphylococcal scalded skin syndrome overview|Overview]]==
The [[syndrome]] is induced by epidermolytic [[exotoxin]]s ([[exfoliatin]])<ref>{{DorlandsDict|three/000037652|exfoliatin}}</ref> A and B, which are released by ''S. aureus'' and cause detachment within the epidermal layer; by breaking down tight-junctions.  One of the exotoxins is produced by the bacterial chromosome, while the other is produced by a [[plasmid]].  (Bacterial plasmids are pieces of self-replicating DNA that often code for secondary characteristics, such as antibiotic resistance, and toxin production.) These exotoxins are proteases that cleave desmoglein-1, which normally holds the [[Stratum granulosum|granulosum]] and [[Stratum spinosum|spinosum]] layers together.


==Signs and Symptoms==
==[[Staphylococcal scalded skin syndrome historical perspective|Historical Perspective]]==


The disease presents with the widespread formation of fluid filled blisters that are thin walled and easily ruptured and the patient can be positive for [[Nikolsky's sign]]. '''Ritter's Disease of the Newborn''' is the most severe form of SSSS with similar signs and symptoms. SSSS often includes a widespread painful erythroderma, often involving the face, diaper, and other intriginous areas. Extensive areas of desquamation might be present. Perioral crusting and fissuring are seen early in the course. Unlike [[toxic epidermal necrolysis]], SSSS spares the mucous membranes. It is most common in children under 6 years, but can be seen in adults who are immunosuppressed or have renal failure.
==[[Staphylococcal scalded skin syndrome pathophysiology|Pathophysiology]]==
 
==[[Staphylococcal scalded skin syndrome causes|Causes]]==
 
==[[Staphylococcal scalded skin syndrome differential diagnosis|Differentiating Staphylococcal scalded skin syndrome from other Diseases]]==
 
==[[Staphylococcal scalded skin syndrome epidemiology and demographics|Epidemiology and Demographics]]==
 
==[[Staphylococcal scalded skin syndrome risk factors|Risk Factors]]==
 
==[[Staphylococcal scalded skin syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


==Diagnosis==
==Diagnosis==
The diagnosis of SSSS is made clinically. This is sometimes confirmed by isolation of ''S. aureus'' from blood, mucous membranes, or skin biopsy; however, these are often negative. Skin biopsy may show separation of the superficial layer of the epidermis, differentiating SSSS from TEN, wherein the epidermal-dermal layer is separated in the latter. SSSS may be difficult to distinguish from toxic epidermal necrolysis and pustular psoriasis.
 
[[Staphylococcal scalded skin syndrome history and symptoms|History and Symptoms]] | [[Staphylococcal scalded skin syndrome physical examination|Physical Examination]] | [[Staphylococcal scalded skin syndrome laboratory findings|Laboratory Findings]] | [[Staphylococcal scalded skin syndrome other diagnostic studies|Other Diagnostic Studies]]


==Treatment==
==Treatment==
The mainstay of treatment for SSSS is supportive care along with eradication of the primary infection. Conservative measures include rehydration, antipyretics, management of thermal burns, and stabilization. Parenteral antibiotics to cover ''S. aureus'' should be administered. Most strains of ''S. aureus'' implicated in SSSS have penicillinases, and are therefore penicillin resistant. Therefore, treatment with Nafcillin, oxacillin, or vancomycin is typically indicated. Clindamycin is sometimes also used because of its inhibition of [[exotoxin|exotoxins]].


==Prognosis==
[[Staphylococcal scalded skin syndrome medical therapy|Medical Therapy]] | [[Staphylococcal scalded skin syndrome prevention|Prevention]] | [[Staphylococcal scalded skin syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Staphylococcal scalded skin syndrome future or investigational therapies|Future or Investigational Therapies]]
The prognosis of SSSS in children is excellent, with complete resolution within 10 days of treatment, and without significant scarring. However, SSSS must be differentiated carefully from toxic epidermal necrolysis, which carries a poor prognosis. The prognosis in adults is generally much worse, and depends upon various factors such as time to treatment, host immunity, and comorbidities.


==History==
==Case Studies==


The clinical features were first described in 1878 by Baron Gottfried Ritter von Rittershain, who observed 297 cases among children in a single Czechoslovakian children's home over a 10-year period.<ref name="pmid15816826">{{cite journal | author = Mockenhaupt M, Idzko M, Grosber M, Schöpf E, Norgauer J | title = Epidemiology of staphylococcal scalded skin syndrome in Germany | journal = J. Invest. Dermatol. | volume = 124 | issue = 4 | pages = 700–3 | year = 2005 | month = April | pmid = 15816826 | doi = 10.1111/j.0022-202X.2005.23642.x }}</ref>
[[Staphylococcal scalded skin syndrome case study one|Case #1]]
 
==Related Chapters==
==See also==
* [[Duke's disease]]
* [[Duke's disease]]
* [[List of cutaneous conditions]]
* [[Toxic epidermal necrolysis]]
* [[List of conditions caused by problems with junctional proteins]]
 
==References==
{{reflist}}


{{Gram-positive bacterial diseases}}
{{Gram-positive bacterial diseases}}
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[[Category:Bacterial diseases]]
[[Category:Bacterial diseases]]
[[Category:Bacterium-related cutaneous conditions]]
[[Category:Bacterium-related cutaneous conditions]]
[[Category:Infectious disease]]
 


{{Cutaneous-infection-stub}}
{{Cutaneous-infection-stub}}
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[[sl:Stafilokokni eksfoliativni dermatitis]]
[[sl:Stafilokokni eksfoliativni dermatitis]]
[[sv:Staphylococcal scalded skin syndrome]]
[[sv:Staphylococcal scalded skin syndrome]]
{{WH}}
{{WS}}

Latest revision as of 19:07, 18 September 2017

For patient information, click here

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Ritter's disease; pemphigus neonatorum; localized bullous impetigo; SSSS.

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Staphylococcal scalded skin syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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Case #1

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