Liy-Wong Carmen, Pope Elena, Weinstein Miriam, Lara-Corrales Irene
Division of Pediatric Medicine, Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Pediatr Dermatol. 2021 Jan;38(1):149-153. doi: 10.1111/pde.14470. Epub 2020 Dec 1.
Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated, blistering skin disorder that mainly affects infants and children. There is limited literature regarding pediatric SSSS. The purpose of this study was to describe the epidemiology, clinical features, and management of pediatric SSSS.
Retrospective cohort study of pediatric patients with a clinical diagnosis of SSSS seen at the Hospital for Sick Children in Toronto, Ontario, Canada, from January 1994 to March 2016.
We included 84 patients with a clinical diagnosis of SSSS; 49/84 (58%) were male. Mean age of diagnosis was 3.1 ± 2.4 years. All patients presented with erythema and exfoliation, while 64/84 (76%) presented with vesicles/ bullae. Skin tenderness was the most common symptom, present in 68/84 (81%) subjects. Staphylococcus aureus was more commonly isolated from periorificial cultures than from bullae. Mean hospitalization was 4.7 ± 2.3 days. No difference was found in admission duration between children receiving clindamycin and those that did not (3.6 ± 2.2 vs 3.9 ± 2.34 days, P = .63). Skin debridement was the only risk factor leading to more complications and prolonged hospitalization (P = .03). Severe complications were seen in 4 (5%) cases, and no fatalities were observed.
Healthcare providers should be aware of SSSS and consider it in the differential diagnosis of infants and children with new onset erythema, exfoliation, and/or vesiculation. Suspected culprit pathogens were more often obtained from periorificial swabs; however, these isolates were not tested for exfoliative toxin to confirm causality. Antibiotic treatment should be guided by sensitivity testing. Addition of clindamycin as an anti-toxin agent had no effect on the duration of hospitalization, and this should be further investigated. Surgical debridement of the skin in patients with SSSS should be discouraged.
葡萄球菌烫伤样皮肤综合征（SSSS）是一种由毒素介导的水疱性皮肤疾病，主要影响婴幼儿。关于儿童SSSS的文献有限。本研究的目的是描述儿童SSSS的流行病学、临床特征及治疗方法。
对1994年1月至2016年3月在加拿大多伦多病童医院临床诊断为SSSS的儿科患者进行回顾性队列研究。
我们纳入了84例临床诊断为SSSS的患者；49/84（58%）为男性。诊断时的平均年龄为3.1±2.4岁。所有患者均出现红斑和脱皮，64/84（76%）出现水疱/大疱。皮肤压痛是最常见的症状，68/84（81%）的患者出现该症状。从口周培养物中分离出金黄色葡萄球菌的情况比从水疱中更常见。平均住院时间为4.7±2.3天。接受克林霉素治疗的儿童与未接受克林霉素治疗的儿童在住院时间上没有差异（3.6±2.2天对3.9±2.34天，P = 0.63）。皮肤清创是导致更多并发症和住院时间延长的唯一危险因素（P = 0.03）。4例（5%）出现严重并发症，未观察到死亡病例。
医疗保健提供者应了解SSSS，并在对新发红斑、脱皮和/或水疱的婴幼儿进行鉴别诊断时考虑该病。疑似致病病原体更常从口周拭子中获得；然而，这些分离株未进行剥脱毒素检测以确认因果关系。抗生素治疗应以药敏试验为指导。添加克林霉素作为抗毒素药物对住院时间没有影响，对此应进一步研究。不建议对SSSS患者进行皮肤手术清创。
