Staphylococcal scalded skin syndromeL00.-

Knight of Rittershain 1878; Lyell,1956

Staphylococcus toxin induced, mostly severe (often intensive care) extensive dermatitis with extensive detachment of the skin. The blister formation is localized intraepithelially.

Staphylococcus aureus, mostly phage group II, here especially type 3A, 3C, 55 and 71

Causative are the exfoliative toxins (Exfoliatins A,B) forming staphylococci. As highly specific serine proteases, these circulating exfoliatins cause the cleavage of intercellular compounds of the epidermis(desmoglein I - is only formed within the epidermis) and thus lead to the dissolution of the keratinocyte network and an intraepidermal blister. The high level blister formation in the epidermis can be explained by the fact that desmoglein is formed throughout the epidermis, but in the deeper parts desmoglein 3 prevents further acantholysis.

Significantly reduced general condition with fever, skin tension, possibly purulent rhinitis, pharyngitis, otitis or conjunctivitis.
Following the initial symptoms triggered by the staphylogenic local infection, a large, indistinct, bruised, scarlatiniform macular exanthema appears.

Within 1-2 days on the trunk and extremities, formation of large, flaccid, easily bursting blisters. The burst blisters lie like a wet slapped-on cloth on the underlying red areas of skin. Positive Nikolski sign.

Desiccation of the blister blanket, coarse lamellar fatty desquamation. Here, the skin shreds can be easily peeled off from the underlay like a thin cellophane skin.

Subcorneal bladder: Acantholytic cleavage within the stratum granulosum.

Diagnosis by frozen section: Carefully remove a piece of the bladder roof with scissors and tweezers, place in saline solution, frozen section in a histological laboratory using cryostat technique and staining with methylene blue. Determination of the level of blister formation in the epidermis.

Immediate high-dose antibiotic administration: penicillinase-safe penicillins i.v., e.g. oxacillin (InfectoStaph) 2-4 g/day in 2-4 ED i.v. Alternatively cephalosporins such as cefuroxime (e.g. Zinacef) 750-1500 mg every 6 h i.v. or cefotaxime (e.g. Claforan) 2 g every 12 h; forced diuresis.

Notice. Glucocorticoids are contraindicated!

In severe courses, balance fluids and parenteral nutrition. Immediate review of the need for intensive care!

With timely therapy reepithelialization within one week. Otherwise severe course.

The"Recalcitrant erythematous desquamating disorder -RED-" is considered a TSS variant. In this clinical picture, the course of the disease is clearly prolonged with about 50 days and characterized by repeated relapses.

The"perineal recurrent toxin-mediated erythema" also belongs to the group of dermatitis caused by staphylococcal toxins.

The"Recalcitrant erythematous desquamating disorder -RED-" is considered a TSS variant. In this clinical picture, the course of the disease is clearly prolonged with about 50 days and characterized by repeated relapses.

The"perineal recurrent toxin-mediated erythema" also belongs to the group of dermatitis caused by staphylococcal toxins.

1. Dobson CM et al (2003) Adult staphylococcal scalded skin syndrome: histological pitfalls and new diagnostic perspectives. Br J Dermatol 148: 1068-1069
2. Hanakawa Y et al (2002) Molecular mechanisms of blister formation in bullous impetigo and staphylococcal scalded skin syndrome. J Clin Invest 110: 53-60
3. Patel GK et al (2003) Staphylococcal scalded skin syndrome: diagnosis and management. At J Clin Dermatol 4: 165-175
4. Pereira FA et al (2007) Toxic epidermal necrolysis. J Am Acad Dermatol 56: 181-200
5. Petzelbauer P et al (1989) Staphylococcal scalded skin syndrome in two adults with acute renal failure. dermatologist 40: 90-93
6. Prevost G et al (2003) Staphylococcal epidermolysins. Curr Opin Infect Dis 16: 71-76
7. Suzuki R et al (2003) Adult staphylococcus scalded skin syndrome in a peritoneal dialysis patient. Clin Exp Nephrol 7: 77-80