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IMAGES IN NEONATOLOGY
Year : 2014  |  Volume : 3  |  Issue : 3  |  Page : 174-175

Rare neonatal dermatological emergency: Staphylococcal scalded skin syndrome (Ritter disease)


Department of Pediatrics, PDU Medical College, Rajkot, Gujarat, India

Date of Web Publication8-Sep-2014

Correspondence Address:
Dr. Mitul B Kalathia
131, Chitrakutdham Society, Kalawad Road, Rajkot - 360 005, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4847.140413

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  Abstract 

A sixteen days old newborn was admitted with exfoliating erythematous lesions over the trunk, face, back and extremities for two days. A diagnosis of Staphylococcal Scalded Skin Syndrome (SSSS) also known as Ritter disease was made clinically. The child responded to Injection amoxycillin-clavulinic acid (Augmentin) and topical fusidic acid. Lesions gradually resolved over 72 hours and child was discharged after ten days of hospitalization. SSSS represents a rare dermatology emergency in neonate which if untreated can be life threatening.

Keywords: Epidermolysis, staphylococcal scalded skin syndrome, Ritter disease


How to cite this article:
Kalathia MB, Parikh YN, Patel DA. Rare neonatal dermatological emergency: Staphylococcal scalded skin syndrome (Ritter disease). J Clin Neonatol 2014;3:174-5

How to cite this URL:
Kalathia MB, Parikh YN, Patel DA. Rare neonatal dermatological emergency: Staphylococcal scalded skin syndrome (Ritter disease). J Clin Neonatol [serial online] 2014 [cited 2021 Aug 2];3:174-5. Available from: https://www.jcnonweb.com/text.asp?2014/3/3/174/140413

Staphylococcal scalded skin syndrome (SSSS), also known as Ritter disease, is an extensive exfoliative skin condition which is common in children under 5 years with good prognosis. [1],[2] Rarely it affects newborns and can be life-threatening due to complications such as sepsis and hypovolemia. SSSS is caused by exfoliative or epidermolytic toxin produced by Staphylococcus aureus. [3] Characteristics features of SSSS are involvement of peri-orificial face, de-epithelialization of friction zones and absence of mucosal involvement. [2],[3] Severity of the disease varies from a localized skin lesion to an extensive generalized condition. [1],[2],[3] Early diagnosis and isolation of the patient is very important to prevent epidemic of staphylococcal infection in nursery.

A 16-day-old newborn came to neonatal intensive care unit of tertiary hospital with complains of skin exfoliation, feeding difficulty and decreased urine output. Before 2 days mother noticed an erythematous rash on the face which rapidly spread to full body within few hours. Following day, skin began to peel off and face, trunk, back and extremities were involved as shown in [Figure 1] and [Figure 2].
Figure 1: Extensive erythematous exfoliating skin rash

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Figure 2: Exfoliating skin rash on back

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Clinical diagnosis of SSSS was considered and newborn was started on amoxillicin + clavulinic acid (augmentin) with amikacin injectable antibiotics. Fusidic acid was applied topically twice a day. Child was able to breast feed from second day and urine output improved so intravenous fluids were stopped.

Septic screen report was negative, blood culture showed growth of S. aureus. Umbilical swab and skin lesion swab cultures were negative. All erythematous exfoliating lesion gradually disappeared in next 72 h and skin healed without any scars.

SSSS is caused by the exfoliative toxins A and epidermolytic toxins B of S. aureus and particularly affects infants and young children. [2],[3] SSSS is rare in newborns due to protection from passively transferred maternal antibodies. [2],[3] Potentially fatal complications include hypothermia, dehydration and secondary infections can occur and endanger life of the newborn. [1],[2] This complications may confuse the diagnosis with toxic shock syndrome (TSS) which usually present with severe systemic features and profound multi-organ failure. [1],[2] Cultures from skin lesions are usually negative but sometimes secondary infected wounds may give positive culture reports. Blood cultures are usually sterile.

The differential diagnosis of SSSS includes drug-induced toxic epidermal necrolysis, epidermolysis bullosa, bullous mastocytosis and herpetic lesions. A rare differential diagnosis would be of TSS, which is mediated by TSS toxin when systemic features of shock and multi-organ failure are present. [3]

 
  References Top

1.Norbury WB, Gallagher JJ, Herndon DN, Branski LK, Oehring PE, Jeschke MG. Neonate twin with staphylococcal scalded skin syndrome from a renal source. Pediatr Crit Care Med 2010;11:e20-3.  Back to cited text no. 1
    
2.Kapoor V, Travadi J, Braye S. Staphylococcal scalded skin syndrome in an extremely premature neonate: A case report with a brief review of literature. J Paediatr Child Health 2008;44:374-6.  Back to cited text no. 2
    
3.Ladhani S, Joannou CL, Lochrie DP, Evans RW, Poston SM. Clinical, microbial, and biochemical aspects of the exfoliative toxins causing staphylococcal scalded-skin syndrome. Clin Microbiol Rev 1999;12:224-42.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]


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Neonatal Network. 2016; 35(1): 8
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