Staphylococcal Scalded Skin Syndrome, Review of 20 Cases / 대한피부과학회지

ABSTRACT

BACKGROUND: Staphylococcal scalded skin syndrome is a relatively uncommon but well described syndrome defined by clinical, microbiological and histological criteria. The spectrum of the disease in children includes not only a severe and acute exfoliative form(generalized form) but also a scarlatiniform eruption(abortive form) and bullous impetigo(localized form). OBJECTIVE: We performed the study to review the clinical, microbiological and histological features of staphylococcal scalded skin syndrome in Korean children. METHODS: We reviewed retrospectively medical records, clinical photographs, microbiologic results and histopathologic findings of 20 cases of staphylococcal scalded skin syndrome diagnosed at Hanyang University Kuri Hospital from February 1998 to November 2001. RESULTS: 1. Of the 20 patients, 13 were generalized type and 7 were abortive type and male to female sex ratio was 11.5. The mean age of onset was 3.2 years. 2. The ordinary cultures from the suspected sites of primary infection revealed methicillin-sensitive Staphylococcus aureus in 7 of the 18 patients, and methicillin-resistant Staphylococcus aureus in 6 of the 18 patients. The colonized sites were conjunctiva(23%), throat(23%), skin(23%), nasal cavity(23%) and ear(8%) in 13 cases. 3. Perioral crusting and fissuring was observed in all cases and the erythema was accentuated in the flexural areas. 4. Histopathologic findings of 11 cases showed intraepidermal cleavage, with splitting occuring beneath and within the stratum granulosum. In 6 of 8 generalized forms, several acantholytic epithelial cells were observed. 5. The coexisting diseases were variable, including atopic dermatitis(5 cases), polycystic kidney disease(1 case) and varicella(1 case). 6. All the patients were treated with first generation cephalosporin and vancomycin therapy without significant sequelae. CONCLUSION: There are no significant relation between clinical types of SSSS and causative organisms. Methicillin-resistant Staphylococcus aureus may induce generalized form and abortive form of staphylococcal scalded skin syndrome but should be confirmed by production of exfoliation in the new-born mouse assay.