Skin Disorders Case

A 5-year-old previously healthy boy is hospitalized with a 3-day history of malaise, fever, and generalized erythema.
Skin Disorders Case

He complains of skin pain. He was given acetaminophen (Tylenol) for the past 3 days without relief. Examination is notable for flaccid bullae and desquamation of the chest and axillae. Oral, ocular, and genital mucosae are clear. Touching the skin causes it to slough.

What is the most likely diagnosis?

A. Bullous impetigo.

B. Morbilliform drug eruption.

C. Pemphigus vulgaris.

D. Staphylococcal scalded skin syndrome.

E. Toxic epidermal necrolysis.

The correct answer is “D.” Staphylococcal scalded skin syndrome (SSSS) is caused by an exotoxin secreted by Staphylococcus aureus. This toxin targets the proteins that bind keratinocytes (epidermal skin cells) together. Disruption of these bonds leads to superficial sloughing of the skin. Bullous impetigo arises as a single or multiple cutaneous erosions, as the blisters rupture easily. It has the same etiology as SSSS (toxin mediated) but is more localized and does not cause diffuse erythema. Morbilliform drug eruptions present as erythematous macules and papules that start on the trunk and spread to the extremities. Pemphigus vulgaris and toxic epidermal necrolysis (TEN) lead to blisters at the level of the dermoepidermal junction, resulting in higher morbidity and mortality. Both pemphigus vulgaris and TEN are associated with severe mucosal involvement.


Question & Explanation: Peterson AR, Wood KE. Pediatrics Examination and Board Review. New York, NY: McGraw-Hill Education; 2017.

Photo: Zaoutis LB, Chiang VW. Comprehensive Pediatric Hospital Medicine, 2e; 2017