Staphylococcal scalded skin syndrome (SSSS).
SSSS begins as a bright, scarlatiniform, erythematous rash, predominating in periflexural and periorificial areas. Rapidly, the superficial part of the epidermis is shed, with extensive peeling, or superficial blistering, and a positive Nikolsky sign. This desquamation phase lasts 2 to 4 days and is followed by complete healing, without scarring. Complications may include dehydration, hypothermia, and generalized sepsis.
Differential diagnosis includes all neonatal bullous eruptions. The onset after a few days helps in differentiating infectious blisters from epidermolysis bullosa.
SSSS is extremely rare in low birth weight newborns, but it may be a very severe and fatal disease. In other cases, the prognosis is good, provided adequate measures are taken:
• Intravenous antimicrobials
• Isolation in an incubator
• Nontraumatic skin care, including the use of emollients (sterile petrolatum, paraffin oil); the shedding epidermis must be conserved as a “biologic dressing”