Staphylococcal scalded skin syndrome

Abstract

Introduction: Staphylococcal scalded skin syndrome (SSSS) is exfoliative skin disease that mostly affects newborns but can also occur in older children. This syndrome is caused by exotoxins produced by Staphylococcus aureus. The severity of the disease varies from being a localized skin lesion to amore extensive generalized condition, characterized by cutaneous erythema followed by desquamation of the epidermal layer of the skin. Prompt antibacterial treatment is essential for good prognosis. Case description: A six-day-old full-term newborn admitted to emergency room with erythematous scalded lesions allover the body which started around navel two days ago, without history of trauma or burns after birth. During the examination, painful scalded skin was observed on the torso, face, limbs and perineum. Body temperature was normal. Other body system examinations were normal. Blood tests showed elevated CRP and a left shift in leukogram. In case of severe condition and suspected SSSS the patient was hospitalized to Neonatal Intensive Care Unit. Blood and skin cultures were taken, empiric treatment with gentamicin and oxacillin was started. After skin culture came positive to oxacillin sensitive Staphylococcus aureus, treatment with gentamicin was stopped. Blood culture was negative. Symptomatic treatment included paracetamol, morphine, midazolam, intravenous fluids and enteral nutrition. Skin care with emollients for dry patches and chlorhexidine solution for moist areas was recommended by dermatologist. The treatment was effective and skin condition improved, weeping areas became dry, inflammatory markers decreased. Enteral nutrition was discontinued and breast milk was started. After 9 days, the newborn was transferred to the neonatal unit in stable condition, skin erythema kept decreasing, no new lesions were found. The erythroderma completely decreased after 16 days, and the newborn was discharged home. Conclusions: This case report demonstrates that SSSS maybe an emergency case in neonate. Early diagnosis and appropiate treatment can prevent mortality and complications.