Staphylococcal scalded skin syndrome

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Staphylococcal Scalded Skin Syndrome. Definition. Etiology. Pathophysiology.Diagnosis.Treatment

Text of Staphylococcal scalded skin syndrome

  • 1. STAPHYLOCOCCAL SCALDED SKIN SYNDROME
  • 2. Etiology caused predominantly by phage group 2 staphylococci, particularly strains 71 and 55 found in nasopharynx and, less commonly, the umbilicus, urinary tract, a superficial abrasion, conjunctivae, and blood spreads hematogenously Nelsons Textbook of Pediatrics. 19th Edition
  • 3. Epidemiology predominantly in infants and children younger than 5 years of age and rarely occurs in adults Due to circulating antibodies and renal excretion of toxins most cases are caused by type 71 strain (75%) no differences in incidence based on gender nor economic status Nelsons Textbook of Pediatrics. 19th Edition Schwartz, M. William. The 5 minute pediatric consult. 2nd ed.
  • 4. PATHOPHYSIOLOGY Caused by an exfoliative toxin: ETA and ETB The toxins likely act as proteases that target the protein desmoglein-1 (DG-1) Exotoxin causes separation of the epidermis beneath the granular cell layer.
  • 5. PATHOPHYSIOLOGY
  • 6. PATHOPHYSIOLOGY
  • 7. PATHOPHYSIOLOGY
  • 8. DIAGNOSIS Gram stain or Culture: from the remote site of infection Skin biopsy or Frozen Section PCR
  • 9. Management
  • 10. Pharmacologic Systemic therapy, either orally, in cases of localized involvement, or parenterally, with a semisynthetic penicillinase-resistant penicillin, should be prescribed because the staphylococci are usually penicillin resistant Clindamycin may be added to inhibit bacterial protein (toxin) synthesis
  • 11. Review of Medication: Hydroxyzine 2mg/ml, 2.5 ml every 6 hours PRN for pruritus Mupirocin ointment, apply over nasal mucosa using cotton buds, 3x a day for 7 days Erythromycin eye oitment, 1 strip to both lower lids 2x a day Cloxacillin 250mg/ml, 2ml every 6 hours on an empty stomach, 1 hour prior to meals
  • 12. Non-pharmacologic The skin should be gently moistened and cleansed. Application of an emollient provides lubrication and decreases discomfort. Topical antibiotics are unnecessary.
  • 13. Prognosis Recovery is usually rapid, but complications such as excessive fluid loss, electrolyte imbalance, faulty temperature regulation, pneumonia, septicemia, and cellulitis may cause increased morbidity.
  • 14. Blepharitis Chronic inflammation of the eyelid Associated with tear film disruption Anterior Affecting the anterior lid margin and eyelashes Posterior Affecting the Meibomian glands
  • 15. Symptoms Watery eyes Red eyes Burning sensation in eyes Eyelids that appear greasy Itchy eyelids Red, swollen eyelids Flaking of the skin around the eyes Crusted eyelashes upon awakening Eyelid sticking More frequent blinking Sensitivity to light Eyelashes that grow abnormally (misdirected eyelashes) Loss of eyelashes
  • 16. Anterior Blepharitis Staphylococcal bacteria Seborrheic dermatitis Manifestations Foreign body sensation, burning sensation, matting of eyelashes, ring like formation around the lash shaft Presence of madarosis, chalazion or hordeolum
  • 17. Posterior Blepharitis Inflammation of eyelids secondary to dysfunction of meibomian glands Associations Rosacea Facial redness Demodex mites Affinity for hair follicles
  • 18. Treatment Proper hygiene This condition is primarily treated with advocating cleaning of the affected area regularly Warm water and mild shampoo for eyelashes Antibiotics Steroid Eyedrops Artificial Tears
  • 19. An innovative local treatment for staphylococcal scalded skin syndrome E. Mueller & M. Haim & T. Petnehazy & B. Acham-Roschitz & M. Trop
  • 20. Case Report Male infant Different congenital malformations Delivered via caesarean section at 36 weeks AOG due to oligohydramnios Left lower limb deformity consisting of tibial and distal femoral aplasia, club foot and mirror foot Multiple vertebral anomalies at different levels of the spine Renal agenesis on the right and hydronephrosis on left kidney
  • 21. Course in the Ward 11 months of age Severe diaper dermatitis with ulceration caused by intractable diarrhea secondary to short bowel syndrome and renal insufficiency Microbial analysis: presence of Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae and Enterococcus faecalis, and S. aureus.
  • 22. Course in the Ward 14 months of age: Developed fever, malaise and more irritable Erythematous rash on skin of the trunk and facial area tender and painful skin and small flaccid bullae erupted Cefuroxime IV, increased parenteral fluid support and transferred to childrens burn unit
  • 23. Course in the Ward Skin biopsy (right flank): mid-epidermal cleavage with minimal inflammation Culture: methicillin-sensitive S. aureus (MSSA) producing ETB Cefuroxime IV was adapted based on the impaired renal function Suprathel treatment as a whole-body dressing
  • 24. Staphylococcal Scalded Skin Syndrome Standard treatment: systemic antibiotics Silver sulfadiazine is not recommended for SSSS Steroids are contraindicated on the basis of both experimental and clinical evidence Severe blistering skin diseases are better managed in burns units Core temperature and room temperature need to be monitored carefully
  • 25. Suprathel Synthetic copolymer consisting mainly of DL- lactide (>70%), trimethylene carbonate and - caprolactone Imitates the properties of natural epithelium and consists of a membrane with 80% porosity Permeable to oxygen and moisture
  • 26. With Suprathel in place: Relieves pain Prevents heat loss and secondary infection Accelerates wound healing Does not need to be changed (daily care is easier)