Dermatologic Manifestations of Staphylococcal Scalded Skin Syndrome Workup

Updated: Apr 25, 2017
  • Author: Elizabeth U Rogozinski, MD, MS; Chief Editor: Dirk M Elston, MD  more...
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Workup

Laboratory Studies

The definitive diagnosis of staphylococcal scalded skin syndrome (SSSS) depends on culture, biopsy results, and polymerase chain reaction (PCR) of circulating toxin.

Examination of frozen sections of the lesions can easily confirm the diagnosis. Shave or punch biopsy with full-thickness specimens is the recommended technique for biopsy. Painless unroofing of bullae can also provide a reliable sample. [35]

Slide latex agglutination, double immunodiffusion, and enzyme-linked immunosorbent assay tests can identify the toxins responsible for SSSS.

Cultures should be performed in all patients with suspected SSSS for identification and antibiotic sensitivities of the causative organism. S aureus may be cultured from the conjunctiva, nasopharynx, feces, or pyogenic foci on the skin. In neonates, culturing the umbilicus and circumcision site also is critical. Although bullae usually are sterile in SSSS, culturing from likely sources of the focus of infection should result in positive cultures. Blood cultures are almost always negative in children, but they may be positive in adults. [21]

Investigate the possibility of a staphylococcal carrier in the vicinity especially in neonates within a nursery or infants and children in day care centers.

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Histologic Findings

All forms of scalded skin syndrome are characterized by intraepidermal, subcorneal cleavage with splitting that occurs beneath and within the stratum granulosum. The cleavage space may contain free-floating or partially attached acantholytic cells. The remainder of the epidermis appears unremarkable, and the dermis contains no inflammatory cells or bacteria.

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