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DERMATOLOGY

COMPLICATIONS

■ Very contagious, easily spreading to surrounding skin and other young children

■ Lymphadenitis, acute poststreptococcal glomerulonephritis (seen in 1%

during epidemics)

STAPHYLOCOCCAL SCALDED SKIN SYNDROME (STAPHYLOCOCCAL

EPIDERMAL NECROLYSIS)

SYMPTOMS/EXAM

■ Usually in children <6 years old with S. aureusinfections of the conjunc-

tiva, nasopharynx, or umbilicus

■ Caused by an exotoxinproduced byS. aureusthat is released into the

bloodstream causing superficial separation of the skin and widespread

painful erythema and blistering.

DISEASECOURSE

■ Phase One: Sudden appearance of tender erythema with sandpaperlike

texture prominent in perioral, periorbital, and groin regions and in skin

creases of the neck, axilla, popliteal, and anticubital regions; mucous

membranes are not affected

■ Phase Two: Exfoliative phase begins on second day of illness. Minor

trauma causes skin to wrinkle and peel off. There is positive Nikolsky sign.

Large flaccid, fluid-filled bullae and vesicles appear, which easily rupture

and are shed in large sheets. Underlying skin resembles scaled skin.

■ Phase Three: After 3–5 days the skin desquamates, leaving normal skin in

10–14 days.

DIFFERENTIAL

■ TEN: Associated with use of medication, occurs in adults, involves mucous

membranes

■ TSS

■ Exfoliative drug eruptions

■ Localized bullous impetigo

TREATMENT

■ Generalized disease requires hospitalization and parenteral abx

■ Fluid resuscitation, correct electrolyte abnormalities, identify and treat

source of staph infection with penicillinase-resistant penicillins such as

oxacillin or vancomycin (depending on prevalence of CA-MRSA); steroids

are not recommended

■ Skin care with bland emollients

COMPLICATIONS

■ 3% mortality in children

■ Disease is very rare in adults, is associated with renal failure and immuno-

supression, and a higher mortality rate >50%.

TOXIC SHOCK SYNDROME

SYMPTOMS/EXAM

■ Toxic shock syndrome presents as acute febrile illness with high fever

(>102°F), myalgias, vomiting, diarrhea, headache, and pharyngitis. Rapid

progression to hypotensive shock can occur.