Staphylococcal scalded skin syndrome

There is conflicting evidence as to whether the ETs, which cause scalded skin syndrome, are superantigens; structural data suggest that they may instead be related to the serine proteases.

Staphylococcal scalded skin syndrome encompasses a range of cutaneous diseases of varying severity caused by ET-producing strains of S. aureus. The most severe form of staphylococcal scalded skin syndrome is termed Ritter's disease in newborns and toxic epidermal necrolysis in older individuals.

The rarity of the syndrome in adults has been ascribed to acquired immunity to the inciting toxins, to enhanced renal clearance of the toxins, and perhaps to diminished sensitivity to the action of the toxins.

The essential elements of therapy for staphylococcal infections are drainage of purulent collections of pus, debridement of necrotic tissue, removal of foreign bodies, and administration of antimicrobial agents. Transmission of S. aureus¾and hence the incidence of staphylococcal infection within an institution¾can be reduced most effectively by meticulous hand washing before and after contact with patients. Staphylococcal skin and soft tissue infections may recur once a person has been colonized with a virulent strain. In this context, therapy directed at the elimination of staphylococcal colonization may be warranted, especially for patients at particular risk for complications of infection.

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