Staphylococcal Scalded Skin Syndrome (SSSS)
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STAPHYLOCOCCAL SCALDED SKIN SYNDROME (SSSS)REPORT OF A RARE CASE IN AN ADULT AND MANAGEMENT WITH MEBOOumeish Youssef Oumeish, M.D, FRCP (Glasgow) Jordan Laser Center, Amman-Jordan Visiting Professor, Tulane University, School of Medicine New Orleans, Louisiana, USA
Clinical Picture:A 78 year old male who developed right hemiplegia due to brain tumor.Six weeks after he was discharged from hospital he developed SSSS at home .Early symptoms were: fever, irritability, and sever skin tenderness.Two days later he developed generalized erythema and oedema all over his skin.One day later he developed flaccid red bullae over his chest , abdomen, back and proximal parts of extremities.
Clinical Picture:The skin appearance looked like a second degree burn.As if it was caused by a boild liquid.Tow days later, the flaccid bullae started to slough and desquamate.Treatment was started when the clinical diagnosis was made.Exfoliation was gradually replaced by re-epithelialization and healing was without scarring.The patient was cleared from all symptoms after 10 days from the beginning of treatment.To our knowledge this is the first reported case of SSSS that occurred in an aged male.
(SSSS):It is also called Ritters Disease, and pemphigus Neonatorum.It is primarily a disease of children below age 6.Occasionally occur in adults only in association with: - chronic renal failure. - Immuno suppression It is considered part of a spectrum of staphylococcal toxin-mediated infection which includes: - Bullous Impetigo. - Toxin shock syndrome.
(SSSS):Most cases are caused by phage group 2 strains (types 3A, 3C, 5S, 7D) of staphylococcus aureus.The exfoliative toxins ET-A (Chromosomally encoded) and ET-B (Plasmid encoded) at the granular layer of the epidermis to cause sterile bullae. The toxins are rarely excreted. N.B: Coded means To transmit a message into a telegraphic code (Cipher).
(SSSS):Pathology:Sharply demarcated zone of cleavage (blister) in the granular layer or below the stratum granulosum.Occasional acantholytic cells within the blister.Subcorneal pustules.Mild necrotic epidermal cells.Moderately dense superficial perivascular, mixed cell infiltrate containing neutrophils.No organisms could be seen on Gram stain.
(SSSS):Treatment of our case:Good nursing care similar to that used for patients with burns.MEBO Ointment: we used it smeared and painted on sterile LOMATUELL-H sheets which are wide mesh (10x30 c.m) knitted, 100% cotton impregnated with a hydrophobic (water resistant) ointment basis (white paraffin BP) Manufactured by: (Lohmann +Rancher International). Used twice daily, covering the whole affected skin.
(SSSS):Treatment of our case:
2. MEBO Ointment: is a natural herbal edible origin. It is composed of B-Sitosteral 0.25% as the main active ingredient. The base is composed of sesame oil and bees wax plus 18 amino acids, 4 major fatty acids, vitamins and polysaccharides. Mebo is manufactured by Julphar (U.A.E)
Treatment: MEBO acts as:Optimum physiological moisturizer which is necessary for regeneration and repair.Anti inflammatory: reduces odema and erythema.It has analgesic effect by Protecting injured nerves.Provides local nutrition for wound bed cells.Liquify the necrotic tissues.Isolating and protecting the wound bed from environmental factors.Reducing body fluids loss from damaged burn skin.Promote epithelialization.
3. Cefotraxone (Rocephine) by Roche 1Grm. (Intravenous) Twice daily for 10 days. It is B-Lactamase, an active antibiotic against both gram positone staphylococcal and gram negative bacteria.4. I.V. fluids and electrolytes replacement.5. Sedatives.