Staphylococcal Scalded Skin Syndrome
Contact Precautions
Staphylococcal scalded skin syndrome (SSSS) is a severe skin disorder marked by epidermal erythema, peeling, and necrosis that give the skin a scalded appearance. This disorder is most prevalent in infants ages 1 to 3 months but may develop in children younger than age 5 years; it is uncommon in adults. It follows a consistent pattern of progression, and most children recover fully; however, the mortality rate for adults with SSSS secondary to toxigenic Staphylococcus aureus in the blood is more than 60%. SSSS affects males more than females.
Causes
S. aureus phage group 2 (types 3A, 3B, 3C, 55, or 71) is the causative organism of SSSS. This penicillinase-producing organism releases exotoxins (epidermolytic toxins A and B) that are widely disseminated from a systemic site into the lower layers of the skin. Transmission usually occurs from an asymptomatic carrier.
Predisposing factors may include impaired immunity and renal insufficiency, which are present to some extent in the normal neonate because of immature development of these systems. Rarely, this disorder may affect adults undergoing immunosuppressant therapy.
Complications
SSSS causes death in 2% to 3% of affected children as a result of complications of fluid and electrolyte loss, sepsis, and involvement of other body systems. Septicemia and secondary infections from Candida species and gram-negative bacteria may also occur. Cellulitis, sepsis, and pneumonia may result from SSSS.
Assessment Findings
The patient history includes a prodromal upper respiratory tract infection, possibly with concomitant purulent conjunctivitis, or otitis media. Usually, the patient appears profoundly ill. Inspection reveals characteristic lesions. Exfoliation may appear within 24 to 48 hours of onset. Assessment of vital signs typically reveals a fever. Palpation may reveal tenderness over the lesions.
Visible cutaneous changes progress through the following three stages:
Erythema: Erythema becomes visible usually around the mouth and other orifices; it may spread in widening circles over the entire body surface.
Exfoliation (24 to 48 hours later): With the more common, localized form of the disease, superficial erosions and minimal crusting occur, usually around body orifices, and may spread to exposed skin areas. With the more severe form of SSSS, large, flaccid bullae erupt and may spread to cover extensive body areas. When they rupture, these bullae expose sections of tender, oozing, denuded skin. Intact lesions may not be found because the bullae are fragile; only the erosions may be visible. At first, the patient with this disorder may appear to be sunburned or to have scarlet fever, but inspection of the mouth shows the lack the oral lesions characteristic of scarlet fever.Related posts:
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