Clinical Analysis Of 160 Cases Of Children With Staphylococcal Scalded Skin Syndrome

Background:Staphylococcal scalded skin syndrome(SSSS) was an acute dermatological disease induced by the exfoliative toxins(ETs) of staphylococcal aureus, which was characterized by erythema, fragile bullae and epidermal detachment. Staphylococcal aureus produced at least four serotypes of ETs, of which ETA and ETB can induce SSSS. Moreover, these two ETs targeted desmoglein-1 located in the superficial epidermis, explaining the bullae formation and epidermal detachment.The major clinical manifestation of generalized SSSS included widespread erythema, flaccid bullae, denuded tender skin like scald, Nikolsky sign(+) and radial perioral fissures.Objective:We retrospectively analyzed the 160 clinical cases of children with SSSS to discuss the progress in diagnosis and treatment, which may provide new ideas for the future clinical works.Methods:A retrospective study was performed among 160 cases with SSSS admitted in Children’s Hospital of Chongqing Medical University from Feb 2013 to Feb 2015. Normal distributed continuous data were described as mean±standard deviation (M±S.D) and analyzed using an independent 2-tailed t-test. Skewed data were described as median (interquartile range, IQR) and analyzed by Mann-Whitney U tests. Categorical data was analyzed by the x2 tests, or Fisher’s exact test. The data was processed with SPSS 17.0 using descriptive and inferential statistics. Statistical significance was established if P<0.05.Results:Among the 160 included patients,92 patients(57.5%)were male and the others were female(42.5%); distribution:126 patients (78.8%)from suburban,34 patients(21.3%) from city, the patients from suburban were more than those from city; seasons for onset of SSSS: Jan-Mar:35 patients, April-Jun:11 patients, July-Sep:48 patients, Oct-Dec: 66 patients, taking 21.9%,6.9%,30%,41.3% respectively; the mean age of onset was 2.66±1.77 years. Among the 160 patients, there were 39 patients with obvious inducement:upper respiratory infection (12.5%), infection of skin (5%), impetigo vulgaris (2.5%), the wound of skin (4.4%), the others have no obvious factors. None of the age, gender, area distribution, the peak of temperature, the fever period, the period for bullae, erythema, Nikolsky sign disappearing and the hospitalization have a significant difference between the S.aureus and MRSA groups. In the IVIG group, peak of temperature was higher and the period for Nikolsky sign, erythema disappearing were longer than the non-IVIG group, all of them had a significant difference (P<0.05).In the Compound Glycyrrhizin Injection group, the peak of temperature was higher and the period of fever was longer, while the period for Nikolsky sign, erythema disappearing and the hospitalization were shorter than the non-Compound Glycyrrhizin Injection group. They also had a significant difference (P<0.05). Moreover, the period for Nikolsky sign and erythema disappearing of the phototherapy group were shorter than the non-phototherapy group, which still had a significant difference (P<0.05). All the patients were recovered without any complications.Conclusion:SSSS was mainly occurred from the age of 0-5 years old, the patients from the suburban were more than those from city, the seasons of onset aggregates in Jul-Dec.Upper respiratory infection, infection of skin, impetigo vulgaris, the wound of skin, the depressed immune function were the inducement for SSSS, especially the upper respiratory infection. Patients with MRSA cultured positive still got recovered, when they received penicillinase-resistant penicillins and cephalosporins. For patients with severe SSSS, the IVIG therapy could help decrease the temperature and relieve the clinical symptoms. Compound Glycyrrhizin Injection and phototherapy could reduce the cutaneous inflammation of the patients with SSSS and cure the wound, to some extent. All the patients in our study discharged recovered, the rate for death decreased significantly might due to the early diagnosis, the early treatment, and the combination with IVIG, Compound Glycyrrhizin Injection and phototherapy.