Staphylococcal scalded skin syndrome - 葡萄球菌性燙傷皮膚症候群
References
Staphylococcal Scalded Skin Syndrome 是由於某些類型的葡萄球菌產生的毒素導致皮膚脫落的情況。這在六歲以上的孩子中並不常見。它也可能發生在免疫系統較弱或有嚴重腎臟問題的成年人。主要特徵是發炎後大面積皮膚脫皮。嚴重程度從幾個水泡到大面積皮膚脫落，可能導致體溫嚴重下降和血壓不穩定。
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 個月大的男孩進來，流鼻涕，吃得不好。醫生說這是上呼吸道感染。兩天后，他回來了，因為他的情況沒有好轉，並且出現了新的問題，例如臉部腫脹和口腔周圍皮膚發炎。接下來的兩天裡，男孩的病情越來越嚴重。他的手臂和腿腫脹起來，皮膚開始脫落。回到醫院後，醫生發現他的臉上和皮膚皺褶處出現紅色皮疹，一碰就會變白。他們診斷他患有 staphylococcal scalded skin syndrome (SSSS) ，並開始透過靜脈注射抗生素。
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 歲女孩在前一天被昆蟲叮咬後，全身出現皮疹，皮疹已在 48 小時內出現。檢查期間，她出現了大範圍的皮疹，由融合在一起的小腫塊組成，輕輕擦拭時，她的皮膚出現了尼科爾斯基徵的跡象。沒有跡象表明皮疹影響了她的黏膜。對她的血液檢查沒有顯示任何感染跡象。
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.
此症候群是由金黃色葡萄球菌釋放的表皮鬆解性外毒素（剝落素）A 和 B 誘發的。兒童 葡萄球菌性燙傷皮膚症候群 (staphylococcal scalded skin syndrome) 的預後極佳，治療後10天內完全消退，且無明顯疤痕。然而，必須仔細區分 葡萄球菌性燙傷皮膚症候群 (staphylococcal scalded skin syndrome) 與預後不良的中毒性表皮壞死松解症。
○ 診斷與治療
誤診為異位性皮膚炎等濕疹皮損，應用類固醇軟膏會使皮損加劇。請在塗抹抗生素軟膏時盡快就醫。
#Bacitracin
#First-generation cephalosporins (e.g. Cefradine)
#Bacterial culture
#Third-generation cephalosporins (e.g. Cefditoren Pivoxil)