Staphylococcal scalded skin syndrome - 葡萄球菌性烫伤皮肤综合征
References
Staphylococcal Scalded Skin Syndrome 是由于某些类型的葡萄球菌产生的毒素导致皮肤脱落的情况。这在六岁以上的孩子中并不常见。它也可能发生在免疫系统较弱或有严重肾脏问题的成年人中。主要特征是炎症后大面积皮肤脱皮。严重程度从几个水泡到大面积皮肤脱落，可能导致体温严重下降和血压不稳定。
Staphylococcal Scalded Skin Syndrome is a disease characterized by denudation of the skin caused by exotoxin producing strains of the Staphylococcus species, typically from a distant site. It usually presents 48 hours after birth and is rare in children older than six years. It may also present in immunocompromised adults or those with severe renal disease. The disorder is characterized by significant exfoliation of skin following cellulitis. The severity may vary from a few blisters to system exfoliation leading to marked hypothermia and hemodynamic instability.
Staphylococcal Scalded Skin Syndrome is a disease characterized by denudation of the skin caused by exotoxin producing strains of the Staphylococcus species, typically from a distant site. It usually presents 48 hours after birth and is rare in children older than six years. It may also present in immunocompromised adults or those with severe renal disease. The disorder is characterized by significant exfoliation of skin following cellulitis. The severity may vary from a few blisters to system exfoliation leading to marked hypothermia and hemodynamic instability.
Staphylococcal scalded skin syndrome (SSSS) and bullous impetigo are infections caused by Staphylococcus aureus. Bullous impetigo is due to the local release of these toxins and thus, often presents with localized skin findings, whereas SSSS is from the systemic spread of these toxins, resulting in a more generalized rash and severe presentation. Both conditions are treated with antibiotics that target S. aureus. These conditions can sometimes be confused with other conditions that result in superficial blistering.
一名 10 个月大的男孩进来，流鼻涕，吃得不好。医生说这是上呼吸道感染。两天后，他回来了，因为他的情况没有好转，并且出现了新的问题，例如脸部肿胀和口腔周围皮肤发炎。接下来的两天里，男孩的病情越来越严重。他的胳膊和腿肿胀起来，皮肤开始脱落。回到医院后，医生发现他的脸上和皮肤皱褶处出现红色皮疹，一碰就会变白。他们诊断他患有 staphylococcal scalded skin syndrome (SSSS) ，并开始通过静脉注射抗生素。
A 10-month-old male presented with rhinorrhea and decreased oral intake and was diagnosed with an upper respiratory infection. Two days later, he returned to the clinic due to a lack of improvement and the onset of new symptoms, including facial edema and perioral skin irritation. That evening, he became febrile at 100.4 °F and went to the emergency department at the local children's hospital. No further workup was done and the parents were instructed to continue with the current treatment regimen. Over the next 48 hours, the patient's symptoms worsened with the new onset of bilateral extremity edema and desquamation. The patient was returned to the emergency department. A physical exam was notable for a blanching, desquamating, erythematous rash on the face and creases of the arms, legs, and groin. A positive Nikolsky sign was reported. A clinical diagnosis of staphylococcal scalded skin syndrome (SSSS) was made, and the patient was started on intravenous clindamycin. This case illustrates a severe presentation of SSSS in a pediatric patient, demonstrating the challenges it poses to diagnosis and treatment.
A 10-month-old male presented with rhinorrhea and decreased oral intake and was diagnosed with an upper respiratory infection. Two days later, he returned to the clinic due to a lack of improvement and the onset of new symptoms, including facial edema and perioral skin irritation. That evening, he became febrile at 100.4 °F and went to the emergency department at the local children's hospital. No further workup was done and the parents were instructed to continue with the current treatment regimen. Over the next 48 hours, the patient's symptoms worsened with the new onset of bilateral extremity edema and desquamation. The patient was returned to the emergency department. A physical exam was notable for a blanching, desquamating, erythematous rash on the face and creases of the arms, legs, and groin. A positive Nikolsky sign was reported. A clinical diagnosis of staphylococcal scalded skin syndrome (SSSS) was made, and the patient was started on intravenous clindamycin. This case illustrates a severe presentation of SSSS in a pediatric patient, demonstrating the challenges it poses to diagnosis and treatment.
一名 2 岁女孩在前一天被昆虫叮咬后，全身出现皮疹，皮疹已在 48 小时内出现。检查期间，她出现了大范围的皮疹，由融合在一起的小肿块组成，轻轻擦拭时，她的皮肤出现了尼科尔斯基征的迹象。没有迹象表明皮疹影响了她的粘膜。对她的血液测试没有显示任何感染迹象。
A 2-year-old girl presented a generalised rash with 48 h of evolution, in the context of insect bites on the face on the day before. At observation, she had a generalised micropapular rash with confluent areas and Nikolsky sign. There was no mucosal area affected. Blood cultures were negative.
A 2-year-old girl presented a generalised rash with 48 h of evolution, in the context of insect bites on the face on the day before. At observation, she had a generalised micropapular rash with confluent areas and Nikolsky sign. There was no mucosal area affected. Blood cultures were negative.
该综合征是由金黄色葡萄球菌释放的表皮松解性外毒素（剥落素）A 和 B 诱发的。儿童 葡萄球菌性烫伤皮肤综合征 (staphylococcal scalded skin syndrome) 的预后极好，治疗后10天内完全消退，且无明显疤痕。然而，必须仔细区分 葡萄球菌性烫伤皮肤综合征 (staphylococcal scalded skin syndrome) 与预后不良的中毒性表皮坏死松解症。
○ 诊断和治疗
误诊为特应性皮炎等湿疹皮损，应用类固醇软膏会使皮损加剧。请在涂抹抗生素软膏时尽快就医。
#Bacitracin
#First-generation cephalosporins (e.g. Cefradine)
#Bacterial culture
#Third-generation cephalosporins (e.g. Cefditoren Pivoxil)