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Staphylococcal scalded skin syndrome (Diagnosis (History (FH Skin…
Staphylococcal scalded
skin syndrome
Definition
Acute blistering of the skin
caused by staphylococcus infection
DERMATOLOGICAL EMERGENCY
Epidemiology
Rare
Children and adults
Pathophysiology
Agent
Staphylococcus
Mechanism
Exotoxin cleaves desmogelin reducing intergrity
of superficial epidermis
Renal excretion, risking renal failure
Clinical
presentation
Rash
Well defined erythema
Blistering
Diagnosis
Examination
Derm exam
Well defined erythematous blistering rash, tender
Nikolsky sign: epidermis separates on pressure
Investigations
Bedside
Obs (shock, sepsis)
Bloods
FBC, CRP, U+E, LFT,
blood cultures
Biopsy
Characteristic histology
History
FH
Skin disease
DH
Meds, allergies
PMH
Skin conditions,
other medical conditions
PC/HPC
Any site, acute onset, red/tender/blistering,
spreading, may have associated fever/malaise
SH
Living arrangements, occupation/school,
smoking, alcohol
Management
Conservative
Information, advice, support
Refer to derm ASAP
Monitoring (fluid balance), keeping clean and warm
Medical
IV fluids
Indication: all patients
E.g. 0.9% saline, Hartmanns
Abx
Indication: all patients
E.g. flucloxacillin
