Staphylococcal Scalded Skin Syndrome

Staphylococcal scalded skin syndrome (SSSS) presents as a red rash followed by diffuse epidermal exfoliation.
A prodromal localized S aureus infection of the skin, throat, nose, mouth, umbilicus, or GI tract occurs. Such an infection often is not apparent before the SSSS rash appears.
The following may be noted:

• General malaise
• Fever
• Irritability
• Skin tenderness

Physical

The following may be noted:

• Fever, although patients may be afebrile
• Tenderness to palpation
• Warmth to palpation
• Facial edema
• Perioral crusting
• Most patients do not appear severely ill.
• Dehydration may be present and significant.
• Nikolsky sign (gentle stroking of the skin causes the skin to separate at the epidermis)^{[20, 21]}

Diffuse erythematous rash often begins centrally, is sandpaperlike (progressing into a wrinkled appearance, and accentuated in flexor creases. See the images below.
Staphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP. Staphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP. Bullae are flaccid and ill defined. See the image below.
Staphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP. Exfoliation of skin, which may be patchy or sheetlike in nature, is noted. See the images below.
Staphylococcal scalded skin syndrome. Photograph by David Effron, MD, FACEP

cutaneous larva migrans

• Tingling/prickling at the site of exposure within 30 minutes of penetration of larvae, although Archer describes a case of late-onset cutaneous larva migrans (CLM)^[6]
• Intense pruritus
• Erythematous, often linear lesions that advance
• Often associated with a history of sunbathing, walking barefoot on the beach, or similar activity in a tropical location
• Predispositions to contracting cutaneous larva migrans include the following:

  • Hobbies and occupations that involve contact with warm, moist, sandy soil
  • Tropical/subtropical climate travel
  • Barefoot beachgoers/sunbathers
  • Children in sandboxes
  • Carpenter
  • Electrician
  • Plumber
  • Farmer
  • Gardener
  • Pest exterminator

Physical

• Cutaneous signs of cutaneous larva migrans (CLM) include the following:

  • Pruritic, erythematous, edematous papules and/or vesicles
  • Serpiginous (snakelike), slightly elevated, erythematous tunnels that are 2- to 3-mm wide and track 3-4 cm from the penetration site
  • Nonspecific dermatitis
  • Vesicles with serous fluid
  • Secondary impetiginization
  • Tract advancement of 1-2 cm/d
• Systemic signs include peripheral eosinophilia (Loeffler syndrome), migratory pulmonary infiltrates, and increased immunoglobulin E (IgE) levels, but are rarely seen.
• Lesions are typically distributed on the distal lower extremities, including the dorsa of the feet and the interdigital spaces of the toes, but can also occur in the anogenital region, the buttocks, the hands, and the knees