Snapshot A 3-year-old girl presents to her pediatrician with a widespread rash. She recently had fevers and a sore throat. She has perioral fissues and a desquamating rash in the groin and neck. When light pressure is applied, the skin easily sloughs off. Superficial wound cultures and bacterial cultures are negative. Introduction Staphylococcal scalded skin syndrome. Clinical definition exfoliative skin infection caused by Staphylococcus aureus toxins Epidemiology incidence login to view 1 more bullet demographics login to view 1 more bullet Pathophysiology mechanism of injury login to view 3 more bullets Associated Staphylococcus aureus conditions children login to view 3 more bullets Prognosis survival with treatment login to view 1 more bullet Presentation Symptoms primary symptoms login to view 1 more bullet Physical exam erythematous tender patches progressing to painful desquamation and superficial skin sloughing with “scalded” appearance generalized and flaccid bullae perioral and periorbital fissures mucous membranes not involved positive Nikolsky sign which describes a login to view 1 more bullet distribution is often in the face, neck, groin, axillae, and other flexural surfaces mucosal surfaces not involved (vs. SJS & TEN) Studies Labs blood cultures typically negative superficial wound cultures and bullae fluid cultures are sterile Biopsy indications login to view 1 more bullet Histology intraepidermal cleavage Differential Toxic epidermal necrolysis full thickness epidermal cell necrosis and supepidermal cleavage Bullous impetigo honey-crusted erosions more widespread positive superficial wound cultures Treatment Medical intravenous anti-staphylococcal antibiotics login to view 5 more bullets Complications Secondary infection of denuded skin