Patrick Condry MD, Rochester, NY, USA on
Mar 10, 2005
This is rather limited extent for the diagnosis. I might have
thought of it as a more extensive bullous impetigo!
Brian Maurer PA, Enfield, CT, USA on March
Three pictures are worth a thousand words! How nice to be able
to make a clinical diagnosis on the basis of history and physical
examination alone. (I assume that the lack of recent drug exposure
led the presenter away from a consideration of Stevens-Johnson
Syndrome.) Nice presentation.
Carlos Garcia MD, Oklahoma City, OK, USA on
March 10, 2005
I must admit that I have missed this diagnosis. One in particular
comes to mind, in which I thought the child had Zn deficiency
(necrolytic migratory erythema). Good case, thanks.
Shahbaz Janjua MD, Lalamusa, Pakistan on Mar
An excellent case presentation showing dramatic recovery. A
focus of infection that usually precedes the onset of staphylococcal
scalded skin syndrome prompts the use of drugs including antibiotics
which are in most cases blamed to be the cause of subsequent
blistering eruption by parents. Some physicians may also get
confused to see the abrupt blistering eruption and may be compelled
to use even systemic steroids in severe cases. Eradication of
the focus of infection is important in the management. Supportive
measures also help relieve the symptoms.
Sunil Dogra MD, Dept. of Dermatology, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
on March 10, 2005
The clinical picture in this case is characteristic of SSSS.
Dermatologists are mostly experienced in making correct diagnosis,
however it may be missed by primary care physicians/pediatricians.
We do sometime get children with SSSS referred to our centre
as drug rash or zinc deficiency. Response to treatment with
systemic antibiotics and supportive measures is promising in
Lawrence Eron MD, Honolulu, HI, USA on March
I hadn't realized that SSSS was circumoral in distribution.
It looks a little like eczema herpeticum (except that this kiddo
didn't have eczema). Thanks so much for the excellent photos.
David Elpern MD, Williamstown, MA, USA on
Mar 17, 2005
This is a fine case with good teaching points. I've only see
a couple of similar cases. I remember the first. This was in
1979 and I was a resident and was called to the pediatric emergency
ward to see a very similar child. He looked toxic, had generalized
erythema and the same peculiar exudative crusting around the
mouth and nose. The clinical picture is distinctive and singular.
The beauty is that in children, most do well with appropriate
antibiotics. In adults, the prognosis is worse with a mortality
rate of > 50%.
Hurwitz's Pediatric Dermatology has a good table on SSSS. Here
are the points:
1) Generally in children < 5 yo
2) Caused by epidermolytic toxin usually group II staph
3) Clinical features
a) Fever, tender erythematous skin
b) exfoliation with crusting around mouth, eyes, parfanasal
c) Positive Nikolsky sign
4) Diagnosis by Tzanck or bacterial culture.
Khalifa Shaquie MD, PhD, Professor of Dermatology,
College of Medicine, University of Baghdad, Baghdad, Iraq
on Mar 17, 2005
I would like to make the following comments.
1-SSS could be localised with minimal symptoms.
2-The impetigo like lesion around the mouth is very good clue
for diagnosis.The whole picture could be named impetigo contagiosa
around orifices ?
3-Acrodermatitis enteropathica is chronic process with burn
like lesions localised on typical areas which should not be
confused with SSS
Abir Saraswat MD, Lucknow, India on Mar 28,
Nice representative case. I cannot help but mention a similar
child I am managing at present, who had classical periorificial
and generalized SSSS superimposed on another bullous disorder--
Chronic bullous disease of childhood. The former subsided rapidly
with Cloxacillin syrup, clearly leaving behind the deeper CBDC
bullae. Made an excellent demonstration case for my undergrad
students. I have the clinical photos which I can send to anyone
who is interested.