TEN (Toxic Epidermal Necrolysis)  &

SSSS (Staphylococcal Scalded Skin Syndrome)

 

Etiology:

  1. TEN is caused by drugs, toxins, vaccines & infections that is complement-Ig complex mediated. Seen mostly in adults.
     
  2. SSSS is caused by  toxin elaborated by Group II Staphylococcus.  Seen mostly in pediatric population.

S & S:

  1. Sloughing of the skin is common to both entities. Scarletiform erythema may be seen in both as well but flexural prominence (axilla, inguinal folds) is seen in SSSS.  In addition, perioral sloughing and crusting is seen in SSSS without extensive mucosal involvement.
     
  2. TEN initially may present as EM or SJ.
     
  3. Positive Nikolsky sign (epidermis breaks off easily when pressure is applied) is seen in both.
     
  4. Mucosa is involved in TEN and not in SSSS.  This mucosal involvement can also involve inner mucosal surfaces (guaiac ve(+) stools, micro/macroscopic hematuria).

DX:

  1. On clinical grounds and by skin biopsy. The latter, done by dermatologist/pathologist, shows separation at the level of an upper epidermal layer (granular layer) in the case of  SSSS and at a deeper level of  epidermis in cases of TEN.

Treatment:

  1. IV antibiotics (e.g. nafcillin) to cover Staph. in case of  SSSS.
     
  2. IVF/aggressive fluid & electrolyte management as for any pt with burn (  formula) in both cases.
     
  3. Wound care as per burn pt. Pt must be admitted to burn unit if available.
     
  4. If mucosal involvement, viscous Lidocaine may be used.  Ophthalmology consult recommended.

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