A kid with a rash, again :)

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Staph Scalded Skin Syndrome presents with terrifying skin desquamation but typically heals without scarring within two weeks. This case demonstrates the classic presentation in a three-year-old child with recent URI, highlighting the typical appearance, clinical course, and management principles.

• Staph Scalded Skin Syndrome results from staphylococcal toxins that cleave the epidermis
• Most common in young children, often following upper respiratory infections
• No mucosal involvement - key differentiating factor from Stevens-Johnson Syndrome
• Treatment includes anti-staphylococcal antibiotics and supportive care
• Colonization site may be difficult to identify, often in nares or umbilical region
• Adults with renal disease are at higher risk due to impaired toxin clearance
• Requires burn-like supportive care for temperature regulation and prevention of secondary infections
• Historically had 5% mortality, likely lower with modern intensive care

Stay tuned for our upcoming comprehensive Immunism Medicine Boards preparation resources, featuring videos, questions, summaries, and study guides designed to help you excel on your exam.

Chapters

• 0:00 Updates on Upcoming Resources
• 1:13 Case Presentation: Puzzling Pediatric Rash
• 2:07 Diagnosis and Treatment Discussion
• 3:32 Adult Cases and Risk Factors
• 4:30 Differential Diagnosis and Closing

Transcript

Speaker 1: 0:01

Hey, invictus peeps, let's do a case. Before we do the case, some more updates. I think I do this every time, but still I should tell you. We've been laying down a ton of video content. It's getting edited, it's getting emphasized, questions are being made, summaries are being made, website is being built. This is going to be big. It's going to be huge. It's going to be large. What we're creating here is going to be a dump of all the stuff you need for the Immunism Medicine Boards in video format, in question format, in summary format. And then we are going to do an expanded version of this podcast and we are going to do live events and a whole bunch of stuff. And the idea is that there'll be study guides that you'll just follow along the study guides, you'll do the videos, you'll listen to the audio, you'll do the written stuff, which is sort of based on Corpendium and other things, or just the summaries, and if you follow that through, you're going to come through the other end and get a spectacular score on your exam. So it's not just the old border view that everybody else does. This is going to be ongoing, living, breathing thing that you can subscribe to, and it will ever expand and be revised. All right, coming soon.

Speaker 1: 1:13

Let's do a case. Here's the case. It's a mother who comes in. Young mother comes in with her three-year-old and says what's up with this? And here is what three year old looks like. There was a fever, but there's not now and the kid looks okay, a little bit toxic, maybe Not too bad, and no past medical history. Everything's been going fine Normal vaginal delivery at term, no meds, no allergies. Had a little URI last week and then, as you see in this rash and mom is, as you can imagine, quite concerned. So what do you think is going on here? There is no mucosal involvement, which is a really important part of this, and the kid looks sick. But they're not toxic. They're not, like you know, dying. So what do you think this is? That's right. This is pretty classic.

Speaker 1: 2:04

This is one of the desquamating pediatric rashes. This is scalded skin syndrome. Why does this happen? Well, you get colonized by staph somewhere. That staph is the right form and it secretes a toxin which cleaves your skin at the epidermis and it's terrifying. It looks really scary.

Speaker 1: 2:24

This classically follows an upper respiratory tract infection and if you can find the stuff and a lot of the time you can't. It may be in the nares, it may be in the umbilicus region. If it's a newborn, as I say, a lot of the time you don't actually find where it's coming from and the treatment is supportive. So these kids can become hypothermic, they can get secondary infection, they might need to be sort of have burn like care early on because this can affect a large section of their body surface area. But the amazing thing is that it tends to heal in about two weeks without needing any grafting or anything. It just heals and you give them any stuff staphylococcal therapies to kill the staph, whether you know where it is or whether you don't know where it is, and they get better.

Speaker 1: 3:07

This can also occur in adults. It's much less common in adults, but it classically occurs in adults with renal disease or immune suppressants, because this toxin, this staph toxin, actually gets renally cleared and so if your kidneys aren't working you're at much higher risk of getting this. So you'll often see it in your renal failure, patients on dialysis and other stuff. So staph scalded skin syndrome looks terrifying but actually isn't that terrifying, although I will say that a lot of the textbooks say there is a 5% mortality. That 5% mortality is because of maybe a failure of really good care of the supportive part. So get them into an ICU, get them good peds care sort of, do that burn therapy-like stuff. 5% is a huge mortality, don't get me wrong, I don't think it's that high anymore with proper care.

Speaker 1: 3:58

So no mucosal involvement is the thing that really differentiated from something we've talked about before on the little podcast here, which is Steven Johnson's syndrome, where you get it in the mouth, in the mucosa, or toxic epidermal necrolysis, when over 30% of the skin surface area is involved, can look very similar early on. So this is again one of those, those decormating skin disorders. If you're listening to this on the podcast, you should be watching it on the YouTube because it's very visual. All right, that's it for now. I'll keep putting a few of these out, mostly as a reminder of where we're going with this thing and we hope to have Invictus out pretty soon. All right, herb it out.