Summary Staphylococcal toxic shock syndrome (TSS) is a clinical disease with acute onset of fever, rash, hypotension and multi-organ system involvement. Staphylococcal scalded skin syndrome (SSSS), mostly described in neonate and children, is a superficial blistering disease caused by the exfoliative toxin of specific strains of Staphylococcus aureus. TSS and SSSS rarely occur concurrently in adults. We here describe a 35-year-old woman who was initially referred to dermatology team as toxic epidermal necrolysis. She presented with a rapid epidermal detachment without mucosal involvement, fever and shock, associated with acute kidney injury and transaminitis, severe metabolic acidosis, complicated by COVID-19 infection, and finally succumbed within 36 hours of hospitalization. Early recognition and prompt treatment are the key factors in the management as TSS itself can lead to mortality. Staphylococcal TSS and SSSS are important differential diagnosis to consider in acute epidermal detachment, as not all cases are drug-induced.
Staphylococcal Infections ; Shock, Septic

INTRODUCTIONTraditional Chinese medicine (TCM) has been used as an alternative in treating children with atopic dermatitis (AD) but its efficacy and potential side effects are debatable. We recently used a TCM capsule (PentaHerbs) on 9 children and observed significant reductions in clinical scores of disease severity. However, there have been concerns that the therapeutic effects of many forms of TCM are due to the presence of corticosteroids. The purpose of this study was to evaluate if common corticosteroids are present in PentaHerbs capsules.

MATERIALS AND METHODSPentaHerbs powder was analysed with thin-layer chromatography, infra-red spectrophotometry and liquid chromatography mass spectrometry.

RESULTSHydrocortisone, prednisolone, fludrocortisone and dexamethasone were not detected in the PentaHerbs capsules.

CONCLUSIONCorticosteroids are not present in the 5 familiar herbs that were earlier shown to have efficacy on AD.

Child ; Chromatography, Thin Layer ; Dermatitis, Atopic ; drug therapy ; Drug Combinations ; Drugs, Chinese Herbal ; chemistry ; therapeutic use ; Glucocorticoids ; analysis ; therapeutic use ; Humans ; Mass Spectrometry ; Pilot Projects ; Spectrophotometry, Infrared