Department of Pediatrics, The Alberta Children's Hospital, The University of Calgary, Calgary, #200, 233-16th Avenue NW, Calgary, AB, T2M 0H5, Canada.
Toronto Dermatology Centre, Toronto, ON, Canada.
World J Pediatr. 2018 Apr;14(2):116-120. doi: 10.1007/s12519-018-0150-x. Epub 2018 Mar 5.
Staphylococcal-scalded skin syndrome (SSSS), also known as Ritter disease, is a potentially life-threatening disorder and a pediatric emergency. Early diagnosis and treatment is imperative to reduce the morbidity and mortality of this condition. The purpose of this article is to familiarize physicians with the evaluation, diagnosis, and treatment of SSSS.
A PubMed search was completed in Clinical Queries using the key terms "Staphylococcal scalded skin syndrome" and "Ritter disease".
SSSS is caused by toxigenic strains of Staphylococcus aureus. Hydrolysis of the amino-terminal extracellular domain of desmoglein 1 by staphylococcal exfoliative toxins results in disruption of keratinocytes adhesion and cleavage within the stratum granulosum which leads to bulla formation. The diagnosis is mainly clinical, based on the findings of tender erythroderma, bullae, and desquamation with a scalded appearance especially in friction zones, periorificial scabs/crusting, positive Nikolsky sign, and absence of mucosal involvement. Prompt empiric treatment with intravenous anti-staphylococcal antibiotic such as nafcillin, oxacillin, or flucloxacillin is essential until cultures are available to guide therapy. Clarithromycin or cefuroxime may be used should the patient have penicillin allergy. If the patient is not improving, critically ill, or in communities where the prevalence of methicillin-resistant S. aureus is high, vancomycin should be used.
A high index of suspicion is essential for an accurate diagnosis to be made and treatment promptly initiated.
葡萄球菌性烫伤样皮肤综合征（SSSS），也称 Ritter 病，是一种潜在危及生命的疾病，属于儿科急症。早期诊断和治疗对降低该疾病的发病率和死亡率至关重要。本文旨在使医生熟悉 SSSS 的评估、诊断和治疗。
在 Clinical Queries 中使用“葡萄球菌性烫伤样皮肤综合征”和“Ritter 病”这两个关键词进行了 PubMed 检索。
SSSS 由产毒性金黄色葡萄球菌引起。葡萄球菌剥脱毒素对桥粒芯糖蛋白 1 的氨基端细胞外结构域进行水解，导致角朊细胞黏附破坏和颗粒层内松解，从而形成水疱。主要基于以下发现做出临床诊断：触痛性红斑、水疱和烫伤样脱屑，尤其是摩擦部位、口周结痂/皲裂、尼氏征阳性，且无黏膜受累。在培养结果指导治疗前，必须立即给予经验性静脉用抗葡萄球菌抗生素治疗，如萘夫西林、苯唑西林或氟氯西林。若患者对青霉素过敏，可使用克拉霉素或头孢呋辛。若患者病情无改善、病情危重或所在社区耐甲氧西林金黄色葡萄球菌流行率较高，应使用万古霉素。
为了做出准确诊断并及时开始治疗，高度怀疑是必要的。
