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| Fig. 27.3 Early staphylococcal scalded-skin syndrome demonstrating diffuse erythema and early desquamation. |
Staphylococcal scalded-skin syndrome typically occurs in neonates, infants, or immunocompromised adults. Like bullous impetigo, it is due to group II staphylococci that produce an exfoliatoxin; however, it differs in that the infection occurs at a distant site, such as a conjunctivitis or abscess. In neonates and infants, the kidneys are not able to excrete the exfoliatoxin adequately. The high level of exfoliatoxin produces diffuse, tender erythema associated with fever that rapidly progress to flaccid bullae; the bullae wrinkle and exfoliate, leaving an oozing erythematous base (Fig. 27-3). Mortality in neonates is usually not due to the infection but is secondary to impaired temperature regulation or fluid balance.
Yamasaki O, Yamaguchi T, Sugai M, et al: Clinical manifestations of staphylococcal scalded-skin syndrome depend on serotypes of exfoliative toxins,
J Clin Microbiol 43:1893–1899, 2005.
