Staphylococcal Scalded Skin Syndrome
Staphylococcal scalded skin syndrome is a reaction to a staphylococcal skin infection in which the skin peels off as though burned.
Certain types of staphylococci bacteria secrete toxic substances that cause the top layer of the epidermis to split from the rest of the skin. Because the toxin spreads throughout the body, staphylococcal infection of a small area of skin may result in peeling over the entire body. Staphylococcal scalded skin syndrome occurs almost exclusively in infants, young children, and people with a weakened immune system. Like other staphylococcal infections, staphylococcal scalded skin syndrome is contagious.
Symptoms
Symptoms begin with an isolated, crusted infection that may look like impetigo. In newborns, the infection may appear in the diaper area or around the stump of the umbilical cord. In adults, the infection may begin anywhere. In all people with this disorder, scarlet-colored areas appear around the crusted area within a day of the beginning of infection. These areas may be painful. Then, other large areas of skin distant from the initial infection redden and develop blisters that break easily.
The top layer of the skin then begins peeling off, often in large sheets, with even slight touching or gentle pushing. Within another 1 to 2 days, the entire skin surface may be involved, and the person becomes very ill with a fever, chills, and weakness. With the loss of the protective skin barrier, other bacteria and infective organisms can easily penetrate the body, causing what doctors call superinfections. Also, critical amounts of fluid can be lost because of oozing and evaporation, resulting in dehydration.
Diagnosis and Treatment
A diagnosis is made by the appearance of skin peeling after an apparent staphylococcal infection. If no signs of staphylococcal infection are observed, doctors often perform a biopsy, in which a small piece of skin is removed, examined under a microscope, and sent to the laboratory to be cultured for bacteria (see Section 18, Chapter 202).
Antibiotics given intravenously, such as nafcillin or cefazolin, are started quickly. Treatment continues for at least 10 days. With early treatment, healing takes 5 to 7 days.
The skin must be protected to help prevent further peeling; it should be treated as if it were burned.
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