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• W3164802273 abstract "Melish ME, Glasgow LA. Staphylococcal scalded skin syndrome: the expanded clinical syndrome. J Pediatr 1971;78:958-67. Mellish and Glasgow, in this landmark paper, coined the term staphylococcal scalded skin syndrome (SSSS) in children and evaluated its treatment options in an animal model. These 28 patients had presented with generalized erythema followed by variable degrees of exfoliation and were classified as having either toxic epidermal necrolysis, staphylococcal scarlatiniform eruption, or bullous impetigo. On the basis of similar clinical profile and identical isolation of phage group II Staphylococcus, these heterogenic manifestations were proposed to be regarded as a single expanded clinical syndrome, SSSS. The authors further demonstrated, in neonatal mice models, that initiation of methicillin before the exfoliative phase was effective in ameliorating the course of the disease, whereas corticosteroids lacked a beneficial effect. The authors’ observations on pathogenesis of disease, methicillin therapy, and role of steroids have proven correct. It is established that phage group II staphylococci, particularly strain 55 and 71, lead to clinical manifestations of SSSS by hematogenous release of exotoxins A or B from a distant primary site. These toxins bind and cleave desmoglein-1, leading to splitting of epidermis at granular layer.1Ladhani S. Joannou C.L. Lochrie D.P. Evans R.W. Poston S.M. Clinical, microbial, and biochemical aspects of the exfoliative toxins causing staphylococcal scalded-skin syndrome.Clin Microbiol Rev. 1999; 12: 224-242Crossref PubMed Google Scholar The proposed spectrum of SSSS by authors also stands true except that it is now known that toxic epidermal necrolysis is caused by hypersensitivity phenomenon, a noninfectious etiology, and has different histology. The theory of methicillin therapy postulated in the original report has formed the basis of management of the SSSS. Milder and localized forms of SSSS are treated with oral penicillinase-resistant penicillins. Vancomycin should be considered in areas having high prevalence of methicillin-resistant strains or as a second-line therapy. Clindamycin is also commonly added to decrease toxin production by the organism. Topical antibiotics are not recommended, and use of steroids is contraindicated.1Ladhani S. Joannou C.L. Lochrie D.P. Evans R.W. Poston S.M. Clinical, microbial, and biochemical aspects of the exfoliative toxins causing staphylococcal scalded-skin syndrome.Clin Microbiol Rev. 1999; 12: 224-242Crossref PubMed Google Scholar,2Liy-Wong C. Pope E. Weinstein M. Lara-Corrales I. Staphylococcal scalded skin syndrome: an epidemiological and clinical review of 84 cases.Pediatr Dermatol. 2021; Crossref Scopus (4) Google Scholar Children with SSSS must be isolated to prevent further outbreaks and provided with optimum supportive therapy for best results and least complications. The baptism of SSSS by Melish and Glasgow has stood the test of time!" @default.
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• W3164802273 doi "https://doi.org/10.1016/j.jpeds.2021.02.029" @default.
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