Staphylococcal scalded skin syndrome in Infant/Neonate
In the newborn, presentation generally occurs between 3-7 days of life, with only one reported case of congenital SSSS. Symptoms occur acutely, with sudden onset of fever, irritability, cutaneous tenderness, and characteristic cutaneous eruption. Symptoms of SSSS can occur in conjunction with bullous impetigo. Full recovery occurs in most cases. Sepsis (with multisystemic involvement) and fluid and electrolyte abnormalities are possible.
L00 – Staphylococcal scalded skin syndrome
200946001 – Staphylococcal scalded skin syndrome
Differential Diagnosis & Pitfalls
- Bullous impetigo – Localized with honey-colored crusted plaques, bacteria present in bullae.
- Neonatal candidiasis
- Exanthematous drug eruption
- Drug-induced erythroderma
- Collodion baby
- Conradi disease
- Leiner disease
- Lamellar ichthyosis
- Keratitis-ichthyosis-deafness syndrome (KID syndrome)
- Netherton syndrome
- Epidermolytic ichthyosis – Present at birth and persists despite appropriate antibiotics.
- Toxic epidermal necrolysis (TEN) – Nikolsky's sign only in erythematous areas and mucous membrane involvement, drug induced, high fevers, skin tenderness, mucosal erosions, and skin detachment about 1-3 weeks after the inciting medication is started.
- Ichthyosis bullosa of Siemens (see epidermolytic ichthyosis) – Present at birth and persists despite appropriate antibiotics.
- Epidermolysis bullosa simplex
- Congenital syphilis
- Boric acid poisoning
- Methylmalonic acidemia
- Toxic shock syndrome – High fevers and severe systemic symptoms including vomiting and diarrhea; hypotension quickly ensues; diffuse scarlatiniform exanthem that starts on the trunk (in contrast to face in SSSS).
- Drug hypersensitivity syndrome (DRESS)
- Stevens-Johnson syndrome – Drug induced, high fevers, skin tenderness, mucosal erosions, and skin detachment about 1-3 weeks after the inciting medication is started.
- Scarlet fever – 1 mm erythematous papules, always elevated WBC with left shift, eosinophilia in up to 20% of patients.