Staphylococcal Scalded Skin Syndrome Pediatric Dermatology

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• This retrospective review investigated children with staphylococcal scalded skin syndrome (SSSS; N=84) from a single institution. Skin erythema and exfoliation were present in all cases, and skin tenderness (88%), facial edema (75%), and perioral crusting (73%) were also frequently seen. Periorificial cultures most often identified Staphylococcus aureus. No difference in length of admission occurred when clindamycin was used for antitoxin coverage. However, skin debridement was a risk factor for a longer hospitalization stay (5.8 days vs 3.6; P = .03).

• New-onset erythema, exfoliation, and vesiculation should prompt consideration of SSSS. This study also suggests that surgical debridement of the skin in SSSS should be discouraged, as it may lengthen hospital stay. The role of clindamycin as an antitoxin therapy requires further investigation.

– Margaret Hammond, MD

 Dermatology

Written by

 

 

Joyce M. C. Teng MD, PhD

Staphylococcal scalded skin syndrome (SSSS) is one of the emergent dermatologic skin disorders in young children. This retrospective chart review by Liy-Wong et al highlighted dermatologic findings of SSSS characterized by intense tender erythema and skin fragility on the central face and flexural area. Interestingly, most of the children in this cohort did not have preexisting skin conditions. Culture from periorificial as well as nasopharyngeal areas were high-yield. With proper supportive care and medical treatment guided by culture sensitivity, most of the children only required a short hospital stay. Surgical debridement, on the other hand, prolonged hospitalization. Surprisingly, clindamycin resistance is quite common among patients in this study. Therefore, it is important to take into consideration geographical differences when choosing antibiotic therapy.

Abstract

BACKGROUND

Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated, blistering skin disorder that mainly affects infants and children. There is limited literature regarding pediatric SSSS. The purpose of this study was to describe the epidemiology, clinical features, and management of pediatric SSSS.

METHODS

Retrospective cohort study of pediatric patients with a clinical diagnosis of SSSS seen at the Hospital for Sick Children in Toronto, Ontario, Canada, from January 1994 to March 2016.

RESULTS

We included 84 patients with a clinical diagnosis of SSSS; 49/84 (58%) were male. Mean age of diagnosis was 3.1 ± 2.4 years. All patients presented with erythema and exfoliation, while 64/84 (76%) presented with vesicles/ bullae. Skin tenderness was the most common symptom, present in 68/84 (81%) subjects. Staphylococcus aureus was more commonly isolated from periorificial cultures than from bullae. Mean hospitalization was 4.7 ± 2.3 days. No difference was found in admission duration between children receiving clindamycin and those that did not (3.6 ± 2.2 vs 3.9 ± 2.34 days, P = .63). Skin debridement was the only risk factor leading to more complications and prolonged hospitalization (P = .03). Severe complications were seen in 4 (5%) cases, and no fatalities were observed.

CONCLUSIONS

Healthcare providers should be aware of SSSS and consider it in the differential diagnosis of infants and children with new onset erythema, exfoliation, and/or vesiculation. Suspected culprit pathogens were more often obtained from periorificial swabs; however, these isolates were not tested for exfoliative toxin to confirm causality. Antibiotic treatment should be guided by sensitivity testing. Addition of clindamycin as an anti-toxin agent had no effect on the duration of hospitalization, and this should be further investigated. Surgical debridement of the skin in patients with SSSS should be discouraged.

Pediatric Dermatology

Staphylococcal Scalded Skin Syndrome: An Epidemiological and Clinical Review of 84 Cases

Pediatr Dermatol 2020 Dec 01;[EPub Ahead of Print], C Liy-Wong, E Pope, M Weinstein, I Lara-Corrales 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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