Summary Staphylococcal scalded skin syndrome (SSSS) is typically a clinical diagnosis,1 affecting primarily neonates and children. It is characterised by a diffuse skin disorder with tenderness, erythema, large wrinkled superficial blistering, and desquamation caused by the hematogenous dissemination of exotoxin-producing strains of staphylococcus aureus to the skin.4,10 Hospital admission is required for intravenous anti-staphylococcal antibiotic therapy and supportive care. The rarity of SSSS in adults is best explained by the presence of exotoxins neutralizing antibodies and renal elimination of the toxins.2 Two major risk factors are kidney failure and immunosuppression. Therefore, SSSS in adults warrants thorough evaluation.3 Mortality is also greater than 60% in adults, attributed to predisposing comorbid conditions.1,4 One of the mimickers of SSSS is toxic epidermal necrolysis (TEN). Here, we report a successful treatment of SSSS in an adult with recreational drug abuse and incidental liver cirrhosis possibly secondary to hepatitis C viral infection, after careful exclusion of TEN.
Staphylococcal Scalded Skin Syndrome ; Staphylococcal Infections ; Adult

Staphylococcal scalded skin syndrome (SSSS) is a disease caused by exfoliative toxin. The purpose of this study is to analyze clinical features, laboratory findings and treatment outcome of patients who diagnosed with SSSS in a single institution for 18 years. From January 2001 to December 2018, 137 patients were diagnosed with SSSS at Daegu Fatima hospital. We retrospectively reviewed the 131 patients' medical records except 6 patients who were unable to identify the exact medical records. The median age of the patients was 32 months (5 days to 97 months) and 78% of the patients were under 4 years. The mean annual number of cases was 7.3 ± 3.7, the number of patients was increased since 2013, and occurred mainly from August to January. Skin cultures were performed in 62 patients and methicillin-resistant Staphylococcus aureus was cultured in 37 patients. The result of the treatment was good without the dead patient. SSSS is a disease occurred frequently in young children, at August to January. The number of patients was increased since 2013. MRSA was cultured a lot, but uniform use of glycopeptide is not necessary.
Child ; Clothing ; Daegu ; Humans ; Medical Records ; Methicillin-Resistant Staphylococcus aureus ; Retrospective Studies ; Skin ; Staphylococcal Scalded Skin Syndrome ; Staphylococcus aureus ; Treatment Outcome

PURPOSE: We investigated the clinical features and epidemiology of staphylococcal scalded skin syndrome (SSSS) from year 2006 to 2015 in Changwon city, Korea. METHODS: We reviewed medical records of 69 patients diagnosed with SSSS from year 2006 to 2015. Antibiotic susceptibility testing was performed by agar dilution method. Methicillin-resistant Staphylococcus aureus (MRSA) was phenotypically identified by oxacillin susceptibility testing and genotypically confirmed by the existence of the mecA gene. RESULTS: The median age of patients was 2.0 years (range 0.2–6 years). Three (4.3%), 53 (76.8%), and 13 (18.9%) patients showed the generalized type, the intermediate type, and the abortive type, respectively. Patients occurred throughout the year, but most patients occurred between July and October. MRSA was isolated from 54 of the 60 patients regardless of the clinical types. All patients recovered without any complications. CONCLUSIONS: There was a constant occurrence of SSSS patients caused by MRSA in Changwon area during 2006 and 2015. It is needed to constantly monitor the occurrence of patients with SSSS.
Agar ; Epidemiology ; Gyeongsangnam-do ; Humans ; Korea ; Medical Records ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Methods ; Oxacillin ; Staphylococcal Scalded Skin Syndrome ; Staphylococcus aureus

Staphylococcal scalded skin syndrome (4S) is an exfoliative skin disease caused by Staphylococcus aureus toxins. 4S usually has a benign course in young infants and children; however, it could be fatal in preterm infants, especially very low birth weight infants. We experienced two sequential 4S cases that occurred in the neonatal intensive care unit. One of the patients had complications such as bacteremia and acute kidney injury.
Acute Kidney Injury ; Bacteremia ; Child ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Skin Diseases ; Staphylococcal Scalded Skin Syndrome ; Staphylococcus aureus

OBJECTIVES: Staphylococcal scalded skin syndrome (4S), a blistering dermatosis caused by exfoliative toxins from Staphylococcus aureus, occurs frequently in patients with atopic dermatitis (AD). However, association between 4S and AD has not rarely been reported. We investigated the characteristics of 4S according to AD status.METHODS: The study included 146 children with 4S who visited Busan St. Mary's Hospital from 2007–2018. Clinical features were analyzed from medical records and pictures, and 4S was classified as localized or generalized. We also retrospectively investigated the preceding conditions and test results related to AD.RESULTS: Among 146 patients with 4S, median age was 2.0 years, and 35 (24.0%) had AD. Since 2007, the incidence of both 4S and AD have increased, without obvious seasonal patterns. Generalized and localized disease occurred in 90 and 56 patients, respectively. Twenty-four of 35 patients with AD (68.6%) and 32 of 111 (28.8%) without AD had localized disease. Significant differences were observed between the groups (P = 0.000). Among those with AD, the most common preceding condition was skin infection or unknown (45.2%); however, respiratory disease was the most common (47.9%) among patients without AD. Eosinophil levels were higher in the AD group (P = 0.002), and there were no statistically significant differences in total immunoglobulin E (IgE), Dermatophagoides farinae (Df IgE), egg-white IgE, and culture results between the groups.CONCLUSIONS: Localized 4S frequently occurred without preceding conditions in children with AD and usually arose from skin infection compared to generalized 4S.
Blister ; Busan ; Child ; Dermatitis, Atopic ; Dermatophagoides farinae ; Eosinophils ; Exfoliatins ; Humans ; Immunoglobulin E ; Immunoglobulins ; Incidence ; Medical Records ; Retrospective Studies ; Seasons ; Skin ; Skin Diseases ; Staphylococcal Scalded Skin Syndrome ; Staphylococcus aureus

No abstract available.
Staphylococcal Scalded Skin Syndrome*

OBJECTIVES: Systemic antibiotic therapy with semisynthetic penicillinase-resistant penicillin or vancomycin and clindamycin are recommended for the treatment of staphylococcal scalded skin syndrome (SSSS). This study assessed the rate of antibiotic resistance of Staphylococcus aureus isolated from the anterior nares or skin of children diagnosed with SSSS. METHODS: A retrospective review of the medical records of 25 patients with SSSS between July 2010 and October 2014 was conducted. The clinical characteristics of patients were collected and the antibiotic susceptibility of S. aureus were analyzed using automated systems. RESULTS: The median age of the patients was 22 months (range: 2–95). Ninety-two percent of patients were less than 5 years of age. Nasal swab samples of all patients and skin swab samples of 17 patients were cultured to isolate S. aureus. Twenty-one (84%) of 25 patients were colonized with methicillin-resistant S. aureus (MRSA). The results of swab samples of the other four patients were no growth or isolation of bacteria other than S. aureus. Among 20 strains isolated from the anterior nares, 1 strain (5%) was methicillin-susceptible S. aureus. All 15 strains isolated from the skin were MRSA. All 21 strains isolated from anterior nares or skin were found to be resistant to clindamycin upon evaluation using automated systems. CONCLUSIONS: The rates of methicillin and clindamycin resistance in S. aureus colonized in children with SSSS were very high. Further studies evaluating proper antibiotic regimens and the effectiveness of systemic antibiotic therapy are needed.
Bacteria ; Child* ; Clindamycin ; Colon* ; Drug Resistance ; Drug Resistance, Microbial* ; Humans ; Medical Records ; Methicillin ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Penicillins ; Retrospective Studies ; Skin ; Staphylococcal Scalded Skin Syndrome* ; Staphylococcus aureus* ; Staphylococcus* ; Vancomycin

Introduction: Cushing syndrome caused by application of topical corticosteroids is rarely reported. Systemic side effects like suppression of hypothalamic-pituitary-adrenal axis, growth retardation in children and iatrogenic Cushing syndrome can occur even in small doses of potent topical steroids.1 Case Summary: This is a case of a 3-month old female who was referred to our department due to generalized erythema with desquamation. History revealed that the patient had recurrent eczema and the mother applied an over-the-counter medication containing Ketoconazole+Clobetasol 10mg/500mcg per 7-gram cream thrice daily for ten weeks. The estimated topical steroid applied weekly was around 8.5 grams and at time of admission, the patient had been exposed to approximately 50 grams of a potent topical corticosteroid. The patient presented with fever, irritability, and had positive Nikolsky sign thus managed as a case of staphylococcal scalded skin syndrome associated with topical steroid – induced iatrogenic Cushing syndrome. Unfortunately, patient’s condition worsened and with progressive pneumonia, she expired on the 23rd hospital day. The fatal outcome was due to SSSS which was complicated by progressive pneumonia and topical steroid – induced iatrogenic Cushing syndrome. The complex interplay of these features eventually led to sepsis and death. Conclusion This case highlights the risks related to abuse of potent steroid-containing preparations and the importance of education to prevent severe and catastrophic outcomes of injudicious steroid use.
Staphylococcal Scalded Skin Syndrome

BACKGROUND: Staphylococcal scalded skin syndrome (SSSS) is a blistering disease of superficial skin mediated by Staphylococcus aureus (S. aureus) exfoliative toxin. Generally, SSSS affects mainly infants and children younger than 5 years and has a good prognosis. However, an increasing number of cases of methicillin-resistant S. aureus (MRSA) have been reported recently. OBJECTIVE: The purposes of this study were to evaluate the clinical features and course, to investigate the microbiological manifestations, and to perform antimicrobial susceptibility testing of SSSS among Korean children. METHODS: From March 2003 to July 2016, a total of 141 children were included in this study. The patients were divided into two different groups according to time of onset of their disease: before or after September 2011. We retrospectively reviewed medical records, microbiological results, bacterial detection sites, and antimicrobial susceptibility tests of all participating children. The results of comparison between the two groups were evaluated using the chi-square test. RESULTS: S. aureus infections were identified in all patients. Among all cultured S. aureus specimens, 63.1% (89/141) showed methicillin resistance. Beginning in September 2011, MRSA infection showed a significantly higher prevalence than that previously demonstrated (71.7% vs. 38.8%; p=0.0010). Moreover, MRSA infections were detected on the skin and neck and in the nose (each detected on 61, 41, and 18 occasions, respectively) with overlap observed in many cases. CONCLUSION: In conclusion, since the prevalence of MRSA infection has been gradually increasing in recent years, careful consideration is needed in the selection of antibiotics covering MRSA.
Anti-Bacterial Agents ; Blister ; Child ; Humans ; Infant ; Medical Records ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Neck ; Nose ; Prevalence ; Prognosis ; Retrospective Studies ; Skin ; Staphylococcal Scalded Skin Syndrome* ; Staphylococcus aureus

OBJECTIVE: To realize the risk factors, clinical features, and treatments of Staphylococcal scalded skin syndrome (SSSS).
 METHODS: The clinical features, laboratory findings, and treatment were retrospectively analyzed in 290 patients from Hunan Children's Hospital.
 RESULTS: Of the 290 patients, less than 3 years old children were 76.6%. One hundred and nine patients had induced factors, and 177 patients had elevated white blood cell count. There were 168 patients with SSSS accompanied with fever, 34 patients accompanied with diarrhea, and 58 patients associated with septicemia. Eighty-five patients performed the bacterial cultures of the skin secretions, 21 did the throat swab, and 13 did both of the skin secretions and throat swab. Bacterial culture results showed that 119 samples were positive for Staphylococci. All patients were cured after antimicrobial therapy. The skin lesions were improved in 3.26 d. The mean hospital stay was 6.55 d. Recovery time of the body temperature was 3.48 d in average.
 CONCLUSION SSSS predominates in infants and children under 3 years old, and has tendency to combine with multi-organ symptoms. The early diagnosis and active antimicrobial treatment are the keys of successful treatments.
Anti-Bacterial Agents ; therapeutic use ; Child, Preschool ; China ; Humans ; Infant ; Length of Stay ; Retrospective Studies ; Risk Factors ; Sepsis ; Skin ; microbiology ; Staphylococcal Scalded Skin Syndrome ; diagnosis ; drug therapy ; pathology