Staphylococcal Scalded Skin Syndrome in Darker Skin: Diagnosis and Management

00:01 The diagnosis is based on clinical history and physical examination findings.

00:06 A nice positive sign that you can see in this condition is what's called Nikolsky sign. And what it means is that you get blistering or sloughing off the skin in response to gentle mechanical pressure.

00:20 Bacterial cultures are usually done to try and make the diagnosis.

00:26 Intact blisters are sterile because remember this is due to the hematological dissemination of the toxins.

00:33 So you're not going to find any bacteria in there pustules because it's toxin within the body.

00:40 A skin biopsy is usually performed and one tries to sample the full thickness of the epidermis and superficial dermis so that you can get a representative specimen.

00:53 The differential diagnosis of SSS includes bands, but usually there's a typical history from the mother indicating that the child was exposed to burns. Bullous impetigo is another differential. And we spoke about this.

01:10 And this is due to toxins that are localized to the sites of the skin infection rather than hematological spread that we see in this condition.

01:20 And in bullous impetigo , the culture of bullae will demonstrate staph aureus. Unlike in SSS, Stevens-Johnson syndrome is another differential and of course, toxic epidermal necrolysis.

01:34 It's an subepidermal, blistering and full thickness epidermal necrosis, resulting in deeper erosions.

01:40 And in these two conditions you also get involvement of the mucosa, the mouth, the eyes, and sometimes the genital area.

01:48 Management of this condition involves admission to the hospital because patients are usually sick, and co-management with pediatrician or pediatric dermatologist is prudent.

02:00 In the hospital, antibiotic therapy should be commenced and this is usually involves penicillinase resistant penicillins, e.g. oxacillin, nafcillin, or cloxacillin, but supportive care is also paramount to prevent dehydration.

02:19 Gentle skin care because the skin is fragile and it breaks, and proper wound care and pain management of the patient.

02:29 What's the prognosis of this condition? It's good in childhood, but in adults the mortality can go up to 60%.