Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Staphylococcal scalded skin syndrome

10,691 views

Published on

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

Published in: Health & Medicine

Staphylococcal scalded skin syndrome

  1. 1. 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.
  5. 5. PATHOPHYSIOLOGY
  6. 6. PATHOPHYSIOLOGY
  7. 7. PATHOPHYSIOLOGY
  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)

×