Chapter 56 - Staphylococcal exfoliative toxins

Abstract

Staphylococcal skin infections remain one of the most common childhood conditions. Of these, the staphylococcal scalded skin syndrome (SSSS) produces the most dramatic skin changes, with exfoliation of almost the entire body surface in severe cases. SSSS is caused by the staphylococcal exfoliative toxins, which have an exquisite ability to target and destroy desmoglein-1, a key component of the cytoskeleton in the epidermis. This chapter summarizes the clinical spectrum, histological features, risk factors, and the organisms responsible for SSSS and then focuses on the unique serine protease and superantigenic activities of the exfoliative toxins. Potential areas for future research, including development of new diagnostic tests, specific antitoxin therapies, and targeted drug delivery systems, are also discussed. There is also evidence that the exfoliative toxins possess a unique and specific superantigenic activity, which is separate from their enzymatic activity. Understanding the mechanism of action of the exfoliative toxins and identification of their epidermal target has not only helped us understand the pathogenesis of SSSS, but should also provide useful information on normal skin physiology and other toxin-mediated diseases. In the near future, the toxins will have other useful benefits in dermatology and therapeutics.