Abstract
Staphylococcal scalded skin syndrome (SSSS) and bullous impetigo are infections caused by Staphylococcus aureus. The pathogenesis of both conditions centers around exotoxin mediated cleavage of desmoglein-1, which results in intraepidermal desquamation. Bullous impetigo is due to the local release of these toxins and thus, often presents with localized skin findings, whereas SSSS is from the systemic spread of these toxins, resulting in a more generalized rash and severe presentation. Both conditions are treated with antibiotics that target S. aureus. These conditions can sometimes be confused with other conditions that result in superficial blistering; the distinguishing features are outlined below.
Highlights
Staphylococcal scalded skin syndrome (SSSS), known as Ritter disease, is a potentially life-threatening infection caused by certain strains of Staphylococcus aureus (S. aureus) that release exfoliative toxins
SSSS is most commonly seen in children under the age of six
Aerobic cultures identified methicillin-sensitive S. aureus (MSSA) in 37.3% of patients, methicillin-resistant S. aureus (MRSA) in 3.4% of patients, normal cutaneous flora in 15.3% of patients, a culture with no growth in 15.3% of patients, and 28.8% did not have a culture performed
Summary
Impetigo is the most common bacterial infection in children [25]. It is a highly contagious infection of the skin that affects the superficial layers of the epidermis [26]. The toxins ar 1l0o.cCalizneicdaltoFetahteurseitseasnodfDskiaingnionsfteictWioonrkinupbullous impetigo, due to the presence of lesiona bactTehrieal[e2s7io].ns of bullous impetigo are usually found on the trunk, extremities, and intertriginous areas, such as the axillae, neck folds, and diaper area [26,27]. The blisters rupture, resulting in re annular erosions and a rim of scale This differs from SSSS, which initially presents as diffuse erythema with flexural prominence that over time can progress to flaccid bullae with superficial desquamation. Differentiating between these conditions is essential to guiding treatment. Treatment with rituximab achieves complete remission in 90% of patients within two years
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