View source for Staphylococcal scalded skin syndrome

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'''For patient information, click [[Staphylococcal scalded skin syndrome (patient information)|here]]'''

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{{SK}} Ritter's disease; pemphigus neonatorum; localized bullous impetigo; SSSS.
==Overview==
'''Staphylococcal scalded skin syndrome''' is a [[dermatology|dermatological]] condition caused by ''[[Staphylococcus aureus]]''.

==Pathophysiology==
The [[syndrome]] is induced by epidermolytic [[exotoxin]]s ([[exfoliatin]])<ref>{{DorlandsDict|three/000037652|exfoliatin}}</ref> A and B, which are released by ''S. aureus'' and cause detachment within the epidermal layer; by breaking down tight-junctions.  One of the exotoxins is produced by the bacterial chromosome, while the other is produced by a [[plasmid]].  (Bacterial plasmids are pieces of self-replicating DNA that often code for secondary characteristics, such as antibiotic resistance, and toxin production.) These exotoxins are proteases that cleave desmoglein-1, which normally holds the [[Stratum granulosum|granulosum]] and [[Stratum spinosum|spinosum]] layers together.

==Signs and Symptoms==

The disease presents with the widespread formation of fluid filled blisters that are thin walled and easily ruptured and the patient can be positive for [[Nikolsky's sign]]. '''Ritter's Disease of the Newborn''' is the most severe form of SSSS with similar signs and symptoms. SSSS often includes a widespread painful erythroderma, often involving the face, diaper, and other intriginous areas. Extensive areas of desquamation might be present. Perioral crusting and fissuring are seen early in the course. Unlike [[toxic epidermal necrolysis]], SSSS spares the mucous membranes. It is most common in children under 6 years, but can be seen in adults who are immunosuppressed or have renal failure.

==Diagnosis==
The diagnosis of SSSS is made clinically. This is sometimes confirmed by isolation of ''S. aureus'' from blood, mucous membranes, or skin biopsy; however, these are often negative. Skin biopsy may show separation of the superficial layer of the epidermis, differentiating SSSS from TEN, wherein the epidermal-dermal layer is separated in the latter. SSSS may be difficult to distinguish from toxic epidermal necrolysis and pustular psoriasis.

==Treatment==
The mainstay of treatment for SSSS is supportive care along with eradication of the primary infection. Conservative measures include rehydration, antipyretics, management of thermal burns, and stabilization. Parenteral antibiotics to cover ''S. aureus'' should be administered. Most strains of ''S. aureus'' implicated in SSSS have penicillinases, and are therefore penicillin resistant. Therefore, treatment with Nafcillin, oxacillin, or vancomycin is typically indicated. Clindamycin is sometimes also used because of its inhibition of [[exotoxin|exotoxins]].

==Prognosis==
The prognosis of SSSS in children is excellent, with complete resolution within 10 days of treatment, and without significant scarring. However, SSSS must be differentiated carefully from toxic epidermal necrolysis, which carries a poor prognosis. The prognosis in adults is generally much worse, and depends upon various factors such as time to treatment, host immunity, and comorbidities.

==History==

The clinical features were first described in 1878 by Baron Gottfried Ritter von Rittershain, who observed 297 cases among children in a single Czechoslovakian children's home over a 10-year period.<ref name="pmid15816826">{{cite journal | author = Mockenhaupt M, Idzko M, Grosber M, Schöpf E, Norgauer J | title = Epidemiology of staphylococcal scalded skin syndrome in Germany | journal = J. Invest. Dermatol. | volume = 124 | issue = 4 | pages = 700–3 | year = 2005 | month = April | pmid = 15816826 | doi = 10.1111/j.0022-202X.2005.23642.x }}</ref>

==See also==
* [[Duke's disease]]
* [[List of cutaneous conditions]]
* [[List of conditions caused by problems with junctional proteins]]

==References==
{{reflist}}

{{Gram-positive bacterial diseases}}
{{Cutaneous infections}}

[[Category:Bacterial diseases]]
[[Category:Bacterium-related cutaneous conditions]]
[[Category:Infectious disease]]

{{Cutaneous-infection-stub}}

[[ca:Síndrome de la pell escaldada estafilocòccica]]
[[de:Staphylococcal scalded skin syndrome]]
[[es:Síndrome de piel escaldada por estafilococo]]
[[fr:Épidermolyse toxinique staphylococcique du nouveau-né]]
[[nl:Staphylococcal scalded skin syndrome]]
[[ja:伝染性膿痂疹]]
[[pl:Choroba Rittera]]
[[pt:Síndrome da pele escaldada estafilocócica do recém-nascido]]
[[sl:Stafilokokni eksfoliativni dermatitis]]
[[sv:Staphylococcal scalded skin syndrome]]