Korean J Dermatol.  2013 Feb;51(2):108-118.

Staphylococcal Scalded Skin Syndrome, A Descriptive Review of 17 Korean Patients

• Kim SM
• Kim YJ
• Cho NJ

Abstract

BACKGROUND
Staphylococcal scalded skin syndrome is a superficial blistering skin disease caused by exfoliative toxins of Staphylococcus aureus. Adult cases are rare but accompanied by high mortality rates and poor prognoses. A rapid diagnosis, including distinguishing this disease from toxic epidermal necrolysis, and immediate treatment are essential. An increasing number of methicillin-resistant Staphylococcus aureus cases has been reported recently, which further complicates the treatment options.
OBJECTIVE
We performed this study to evaluate clinical features and courses, and to investigate microbiological and histological manifestations of staphylococcal scalded skin syndrome in Korean children and adults.
METHODS
We retrospectively reviewed, among 14 children (including 2 neonates) and 3 adults, medical records, clinical photographs, microbiological results and histological findings, including frozen section on the blister roof and Tzanck smear in some patients.
RESULTS
The adult patients had longer disease durations than children (mean 24.7 versus 9.9 days). One adult patient died of pneumonia and sepsis. The children recovered without complications. All of cultured Staphylococcus aureus in 11 of the 17 patients were methicillin-resistant. On the frozen sections, the roof of the blister consisted of the uppermost epidermis. Taking specimens from fresh blisters was important for clear diagnosis.
CONCLUSION
Adult patients had longer disease durations and poorer prognoses than children. The frozen section on the roof of fresh blister and the Tzanck smear were convenient methods for early and dependable diagnosis. Given the prevalence of methicillin-resistant strains of Staphylococcus aureus, treating the condition with antibiotics covering this strain should be considered.

Keyword

Adult; Histopathology; Methicillin-resistant Staphylococcus aureus; Neonate; Staphylococcal scalded skin syndrome

MeSH Terms

Adult
Anti-Bacterial Agents
Blister
Child
Epidermal Necrolysis, Toxic
Epidermis
Exfoliatins
Frozen Sections
Humans
Infant, Newborn
Medical Records
Methicillin Resistance
Methicillin-Resistant Staphylococcus aureus
Pneumonia
Prevalence
Prognosis
Retrospective Studies
Sepsis
Skin Diseases
Sprains and Strains
Staphylococcal Scalded Skin Syndrome
Staphylococcus aureus
Anti-Bacterial Agents
Exfoliatins