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Staphylococcal scalded skin syndrome


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Staphylococcal Scalded Skin Syndrome. Definition. Etiology. Pathophysiology.Diagnosis.Treatment

Published in: Health & Medicine

Staphylococcal scalded skin syndrome

  2. 2. 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
  3. 3. 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 Edition Schwartz, M. William. The 5 minute pediatric consult. 2nd ed.
  4. 4. 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.
  8. 8. DIAGNOSIS • Gram stain or Culture: from the remote site of infection • Skin biopsy or Frozen Section • PCR
  9. 9. Management
  10. 10. 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
  11. 11. 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
  12. 12. Non-pharmacologic • The skin should be gently moistened and cleansed. • Application of an emollient provides lubrication and decreases discomfort. • Topical antibiotics are unnecessary.
  13. 13. 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.
  14. 14. Blepharitis • Chronic inflammation of the eyelid • Associated with tear film disruption • Anterior – Affecting the anterior lid margin and eyelashes • Posterior – Affecting the Meibomian glands
  15. 15. 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
  16. 16. 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
  17. 17. Posterior Blepharitis • Inflammation of eyelids secondary to dysfunction of meibomian glands • Associations – Rosacea • Facial redness – Demodex mites • Affinity for hair follicles
  18. 18. 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
  19. 19. An innovative local treatment for staphylococcal scalded skin syndrome E. Mueller & M. Haim & T. Petnehazy & B. Acham-Roschitz & M. Trop
  20. 20. 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
  21. 21. 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.
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. 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)