A newborn develops a widespread blistering eruption within the first 48 hours of life, with Nikolsky sign positive, fever, and erosions over the nose and perioral areas. Skin biopsy shows sub-granular layer cleavage. What is the diagnosis?

• A Staphylococcal scalded skin syndrome (SSSS) ✓
• B Neonatal bullous pemphigoid
• C Epidermolysis bullosa simplex
• D Incontinentia pigmenti

Explanation

Staphylococcal scalded skin syndrome (SSSS) in neonates and young children is caused by exfoliative toxins A and B from Staphylococcus aureus phage group II, which cleave desmoglein-1 in the superficial granular layer of the epidermis. Histologically this produces subcorneal (sub-granular layer) cleavage without bacteria in the blister fluid. Features: fever, tender erythema, bullae with Nikolsky sign, perioral/periorbital involvement, and subsequent desquamation. Treatment is systemic anti-staphylococcal antibiotics (IV cloxacillin or nafcillin). Epidermolysis bullosa is hereditary and shows deeper cleavage. Pemphigoid in neonates is from maternal IgG transplacental transfer and shows sub-epidermal cleavage.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.