Staphylococcal scalded skin syndrome
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STAPHYLOCOCCAL SCALDED SKIN SYNDROME
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Etiology
• caused predominantly by phage group 2 staphylococci, particularly strains 71 and 55
• found in nasopharynx and, less commonly, the umbilicus, urinary tract, a superficial abrasion, conjunctivae, and blood
• spreads hematogenously
Nelson’s Textbook of Pediatrics. 19th Edition
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Epidemiology
• predominantly in infants and children younger than 5 years of age and rarely occurs in adults
• Due to circulating antibodies and renal excretion of toxins
• most cases are caused by type 71 strain (75%)• no differences in incidence based on gender
nor economic status
Nelson’s Textbook of Pediatrics. 19th EditionSchwartz, M. William. The 5 minute pediatric consult. 2nd ed.
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PATHOPHYSIOLOGY
• Caused by an exfoliative toxin: ETA and ETB• The toxins likely act as proteases that target
the protein desmoglein-1 (DG-1)• Exotoxin causes separation of the epidermis
beneath the granular cell layer.
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PATHOPHYSIOLOGY
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PATHOPHYSIOLOGY
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PATHOPHYSIOLOGY
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DIAGNOSIS
• Gram stain or Culture: from the remote site of infection
• Skin biopsy or Frozen Section• PCR
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Management
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Pharmacologic
• Systemic therapy, either orally, in cases of localized involvement, or parenterally, with a semisynthetic penicillinase-resistant penicillin, should be prescribed because the staphylococci are usually penicillin resistant
• Clindamycin may be added to inhibit bacterial protein (toxin) synthesis
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Review of Medication:
• Hydroxyzine 2mg/ml, 2.5 ml every 6 hours PRN for pruritus
• Mupirocin ointment, apply over nasal mucosa using cotton buds, 3x a day for 7 days
• Erythromycin eye oitment, 1 strip to both lower lids 2x a day
• Cloxacillin 250mg/ml, 2ml every 6 hours on an empty stomach, 1 hour prior to meals
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Non-pharmacologic
• The skin should be gently moistened and cleansed.
• Application of an emollient provides lubrication and decreases discomfort.
• Topical antibiotics are unnecessary.
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Prognosis
• Recovery is usually rapid, but complications such as excessive fluid loss, electrolyte imbalance, faulty temperature regulation, pneumonia, septicemia, and cellulitis may cause increased morbidity.
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Blepharitis
• Chronic inflammation of the eyelid• Associated with tear film disruption• Anterior – Affecting the anterior lid margin and eyelashes
• Posterior– Affecting the Meibomian glands
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Symptoms• Watery eyes• Red eyes• Burning sensation in eyes• Eyelids that appear greasy• Itchy eyelids• Red, swollen eyelids• Flaking of the skin around the eyes• Crusted eyelashes upon awakening• Eyelid sticking• More frequent blinking• Sensitivity to light• Eyelashes that grow abnormally (misdirected eyelashes)• Loss of eyelashes
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Anterior Blepharitis
• Staphylococcal bacteria• Seborrheic dermatitis• Manifestations– Foreign body sensation, burning sensation,
matting of eyelashes, ring like formation around the lash shaft
– Presence of madarosis, chalazion or hordeolum
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Posterior Blepharitis
• Inflammation of eyelids secondary to dysfunction of meibomian glands
• Associations– Rosacea• Facial redness
– Demodex mites• Affinity for hair follicles
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Treatment
• Proper hygiene– This condition is primarily treated with advocating
cleaning of the affected area regularly– Warm water and mild shampoo for eyelashes
• Antibiotics• Steroid Eyedrops• Artificial Tears
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An innovative local treatment for staphylococcal scalded skin syndrome
E. Mueller & M. Haim & T. Petnehazy & B. Acham-Roschitz & M. Trop
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Case Report
• Male infant– Different congenital malformations– Delivered via caesarean section at 36 weeks AOG
due to oligohydramnios– Left lower limb deformity consisting of tibial and
distal femoral aplasia, club foot and mirror foot– Multiple vertebral anomalies at different levels of
the spine– Renal agenesis on the right and hydronephrosis on
left kidney
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Course in the Ward
• 11 months of age– Severe diaper dermatitis with ulceration caused by
intractable diarrhea secondary to short bowel syndrome and renal insufficiency
– Microbial analysis: presence of Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae and Enterococcus faecalis, and S. aureus.
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Course in the Ward
• 14 months of age:– Developed fever, malaise and more irritable– Erythematous rash on skin of the trunk and facial
area tender and painful skin and small flaccid bullae erupted
– Cefuroxime IV, increased parenteral fluid support and transferred to children’s burn unit
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Course in the Ward
• Skin biopsy (right flank): mid-epidermal cleavage with minimal inflammation
• Culture: methicillin-sensitive S. aureus (MSSA) producing ETB
• Cefuroxime IV was adapted based on the impaired renal function
• Suprathel® treatment as a whole-body dressing
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Staphylococcal Scalded Skin Syndrome
• Standard treatment: systemic antibiotics• Silver sulfadiazine is not recommended for SSSS • Steroids are contraindicated on the basis of
both experimental and clinical evidence • Severe blistering skin diseases are better
managed in burns units • Core temperature and room temperature need
to be monitored carefully
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Suprathel®
• Synthetic copolymer consisting mainly of DL-lactide (>70%), trimethylene carbonate and ε-caprolactone
• Imitates the properties of natural epithelium and consists of a membrane with 80% porosity
• Permeable to oxygen and moisture
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With Suprathel® in place:• Relieves pain• Prevents heat loss and secondary infection• Accelerates wound healing• Does not need to be changed (daily care is
easier)