ABSTRACT
Clinical features Bullous impetigo (BI), a localized form of blistering disease, and its generalized form, SSSS, are infection mediated [4]. Staphylococcal scalded-skin syndrome typically affects children younger than 5 years. Children affected by the generalized form of the disease usually develop a tender macular exanthem at the beginning, with associated head and neck/upper respiratory tract infection such as conjunctivitis, pharyngitis, or otitis media. From the macular lesions, blisters develop within the subsequent 48 hr, manifesting as large flaccid bullae, particularly around the body orifices and intertriginous areas, such as groin and axillae. The localized bullae then quickly extend to a generalized disease, but sparing
mucous membranes. The shedding of a large epidermal sheet (169) then follows the generalized bullae, leaving behind large denuded areas (170). After desquamation, the skin typically heals in a week, without scarring. The blister fluid in SSSS is sterile. Whereas SSSS in infants and children has a relatively low mortality rate of 5%, SSSS in 50 reported adult cases had a substantially higher mortality rate (around 65%), and is associated with methicillin-resistant bacterial infection.
