Clinical presentation of staphylococcal scalded skin syndrome
Arnold, 2018Brazel, 2021Nguyen, 2022Patel, 2021
Staphylococcal scalded skin syndrome is a severe, superficial blistering skin disorder that usually affects neonates and young children. The prognosis in neonates and young children is good; however, in adults, infection is associated with a mortality of over 40%. Adults with staphylococcal scalded skin syndrome usually have comorbidities (eg diabetes, chronic kidney disease, immune compromise).
In staphylococcal scalded skin syndrome, toxins produced by Staphylococcus aureus are released at the initial site of infection and spread haematogenously to distant sites. These toxins disrupt keratinocyte cell-to-cell adhesion which causes:
- skin tenderness
- erythema (usually appears in the flexures and around the nose and mouth, before becoming generalised)
- blistering
- desquamation.
Staphylococcal skin syndrome is also associated with:
- fever
- irritability
- malaise
- positive Nikolsky sign (skin exfoliation when lateral pressure is applied).
Mucosal membranes are not involved in staphylococcal scalded skin syndrome, which helps differentiate the condition from Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and toxic shock syndrome.
In staphylococcal scalded skin syndrome, lip involvement is generally limited to the outer third, with no intraoral lesionsBrazel, 2021Nguyen, 2022. This differs from TEN, which typically manifests with full-lip surface and mucosal membrane involvement.
A skin biopsy can help differentiate staphylococcal scalded skin syndrome from SJS and TEN; however, this is not routinely required.
For more information on alternative causes of blistering skin conditions, see Causes and diagnosis of blistering skin conditions.