Clinical review of Staphylococcal Scaled Skin syndrome in the recent 15 years

Clinical review of Staphylococcal Scaled Skin syndrome in the recent 15 years

Clinical review of Staphylococcal Scaled Skin syndrome in the recent 15 years

(구연):媛
Release Date : 2017. 10. 26(목)
Seung Jae Lee, Young Kwon Jung, Eun Wook Kwon , Dong Won Lee
Daegu Fatima Hospital Department of Pediatrics1
이승재, 정영권, 권은욱 , 이동원
대구파티마병원 소아청소년과1

Abstract

Purpose : Staphylococcal scaled skin syndrome(SSSS) is a disease caused by exfoliative toxin A and B secreted by Staphylococcus aureus (S. aureus) . Exfoliative toxin acts on desmoglein 1 and the site of cleavage is subcorneal. It is characterized by blistering and desquamation of the skin and Nikolsky’s sign. The aim of this study was to investigate the characteristics and clinical manifestations of SSSS. Methods : We performed a retrospective review of medical records of 108 patients with SSSS between July 2001 and December 2016 in Daegu Fatima Hospital. We analyzed the clinical characteristics, treatment methods, and laboratory data of children diagnosed with SSSS in a single institution for 15 years. Results : The average annual incidence of SSSS was about 6.8 cases, and occurred frequently in autumn and winter. The median age of subjects was 30 months (range: 5 days to 97 months). The patients included 51 boys and 57 girls. Male : Female ratio was 1:1.12. There was no mortality case, the mean hospitalization time was 7.3 ± 2.4 days. 50 patients(46%) had eye discharge, and 33 patients(31%) had fever at the time of admission. The most common lesions were perioral and periocular area. In blood culture, 3 out of 108 patients were found by methicillin-sensitive S. aureus (MSSA), coagulase negative Staphylococcus (CNS) and Streptococcus viridans. In skin culture at 54 sites, the results had 25 in methicillin-resistance S. aureus, 7 in MSSA , and 9 in CNS. All patients were taken intravenous antibiotics and nafcillin was used most frequently. Steroids were used in 39 patients (36%). There was no abnormal finding on the blood test. The duration of hospitalization was significantly lower in the group of patients used steroids compared with those not used steroids( 6.4 ± 1.6 days vs 7.8 ± 2.5 days, P = 0.001). Conclusion : SSSS is a rare disease, more frequent in young children. The incidence rate is high in autumn and winter. It occurs most frequently in perioral and periocular area. Children with SSSS displayed nonspecific laboratory findings, but MRSA was detected in the skin cultures in the majority. Though the use of steroids is controversial, it might reduce the hospitalization time.

Keywords: SSSS, Staphylococcal scaled skin syndrome,