A blistering skin rash in newborns that is caused by toxins on the skin released by staphylococcal bacteria. The disorder primarily affects infants between one to three months of age and occasionally older children and adults.
First recognized as a distinct condition in the mid-1800s, this disease has been incorrectly called by many different names, including Ritter's disease, toxic epidermal necrolysis, and pemphigus neonatorum.
The fatality rate is less than 4 percent. Epidemics have occurred in contaminated nurseries, and the bacteria may be transmitted by a carrier who has no symptoms. The condition has also been reported among adults, most of whom had poorly functioning immune systems.
Cause Recently, scientists discovered the cause of this condition to be a toxin-produc-ing strain of Staphylococcus aureus. Infants with poor immunity or kidney problems are more vulnerable to this infection.
Symptoms The skin rash strongly resembles a burn, with blistering and peeling of the skin giving a scalded appearance. Indeed, some parents have been wrongly accused of child abuse in the face of the symptoms of this disease. First symptoms usually include evidence of a primary staph infection, including impetigo, eye infection, ear infection, or sore throat with fever, malaise, or irritability. The skin of the face becomes tender, and the skin around the mouth becomes reddened, weeping, and crusting in a way that resembles potato chips. The trunk also may become involved.
In some patients the rash stabilizes, whereas in other cases flaccid blisters begin to develop all over the skin within 24 to 48 hours. Large areas of skin slough off, and hair or nails may be lost.
Treatment The condition is treated with prompt administration of antistaphylococcal antibiotics. Patients often appear very ill with dehydration; they are at risk of secondary infection. The skin should be covered with wet dressings and antibiotic ointments such as bacitracin. Patients usually heal without scarring within a week.
It is important to maintain correct body temperature; infants must be kept warm, but any sudden rise in body temperature could indicate blood infection and the immediate need for more aggressive treatment. The skin should be loosely clothed and covered so as to reduce friction. Cotton should be inserted between affected fingers and toes to prevent scarring. Warm baths and soaks help healing and gentle removal of peeling skin will help. Scars from this condition rarely occur.
Staphylococcus aureus A species of Staphylococcus that is responsible for a number of infections such as the boil, carbuncle, abscess, cellulitis, sepsis, and osteomyelitis.
sterilization The complete elimination or destruction of all forms of microbial life. In hospitals, equipment is sterilized with steam, dry heat, gas, or liquid chemicals. Sterilization is rarely needed at home. For most in-home needs (such as bottles and nipples for babies), heating by boiling (disinfection) is sufficient.
steroids See corticosteroid drugs.
St. Louis encephalitis See encephalitis, st. louis.
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