Staphylococcal scalded skin syndrome

This is an acute toxic illness usually seen in infants but can affect adults with renal failure or immunodeficiency (BAD, 2006). It is caused by S. aureus which produces a toxin leading to damage of a key protein called desmoglein which binds skin together. The resulting shedding of sheets of superficial parts of the epidermis resembles a scald, giving rise to the name of the condition (Gawkrodger, 2003).

The original infection can be minor, for example a graze or sticky eye, after which a patchy red rash will develop and quickly spread and increase in size. There is often redness around the mouth but there is no mucosal involvement of the lips or eyes which differentiates this from the more serious toxic epidermal necrolysis (TEN). TEN is a similar looking condition but rare in children and nearly always caused by a drug reaction. The baby or child is usually miserable and feverish and the condition is painful. A thin layer of skin will loosen, with fluid-filled blisters or just with sheets of skin sliding off the underlying areas (BAD, 2006). If large areas of denuded erythematous areas occur, there will be exudate with possible electrolyte imbalance and the risk of septicaemia. Management

1. Swab surface fluid or pus for bacterial culture.
2. Give systemic antibiotics: including Flucloxacillin or Erythromycin which may need to be given intravenously.
3. Clean skin gently and apply emollient, e.g. Liquid and White Soft Paraffin, NPF ointment (WSP:LP 50:50).