Staphylococcal skin scald-like syndrome, formerly known as neonatal exfoliative dermatitis, Staphylococcus aureus-type toxic epidermolysis bullosa, bacterial toxic epidermolysis bullosa, and Ritter’s disease. The disease is a severe acute generalized exfoliative pustulosis occurring in newborns, characterized by the occurrence of flaccid scald-like blisters and large epidermal exfoliation on the base of generalized erythema, mostly in infants, occasionally in adults. Common symptoms: Impetigo, scald-like blisters, large epidermal peeling. Etiology The disease is a serious skin infection mainly caused by coagulase-positive phage group II 71 Staphylococcus aureus. This type of staphylococcus can produce epidermolysis bullosa toxin, causing skin damage. Some staphylococci of group I or III have also been found to produce epidermolysis bullosa toxin, which is found in elevated serum levels and causes skin damage and peeling. Staphylococcal skin burn-like syndrome occurs in adults who have nephritis, uremia, immune deficiency or severe staphylococcal sepsis. Clinical manifestations The disease occurs mostly in infants 1 to 5 weeks after birth, and occasionally in adults. The onset of the disease is sudden, with erythema initially occurring around the mouth or eyelids, then rapidly spreading to the trunk and proximal extremities, and even spreading to the whole body, with obvious tenderness at the lesions. On top of the erythema, flaccid blistering occurs, and within 1 to 2 days, oozing crusts appear around the mouth and eyelids, and large scabs may fall off, leaving a radiating chancre around the mouth. Other parts of the epidermis are superficially wrinkled, and when rubbed slightly, a large area of epidermis is peeled off, revealing a bright red edematous vesicular surface, i.e., positive for Nee’s sign, similar to burns. The epidermis at the edge of the erosion is loosely curled, and the skin of the hands and feet can be peeled off in the form of gloves or socks, and then the peeling area gradually changes from bright red to purplish red and dark red, and no longer peels off, and bran-like flaking occurs, which heals after 7 to 14 days. The oral cavity, nasal mucosa, and conjunctiva can be involved, and stomatitis, rhinitis, and corneal ulcers can occur. Patients often have systemic symptoms such as fever, anorexia, vomiting, and diarrhea. Some die due to secondary bronchopneumonia, sepsis, abscess or gangrene, mostly in infants and young children, with a rapid course and high mortality. Diagnosis Based on the clinical manifestations such as occurrence in infants born at 1-5 weeks, rapid onset, flaccid macules, large epidermal peeling, positive Ney’s sign on the basis of erythema, combined with bacterial culture, the diagnosis is not difficult. If necessary, ET-A, ET-B and ET-D tests can be done. V. Differential diagnosis The disease needs to be differentiated from neonatal impetigo, desquamative erythroderma, and non-golden germ TEN. Treatment 1. Pay attention to the infant’s cleanliness and hygiene, diapers should be clean, and no health care workers or family members with septic skin disease should have contact with the newborn. 2, strengthen care, pay attention to keep warm. Pay attention to oral and eye care. 3, early should use an adequate amount of effective antibiotics to remove the presence of the body of Staphylococcus aureus infection foci, to terminate the production of bacterial toxins. And make antibiotic sensitivity test, so as to choose suitable antibiotics. 4. Pay attention to water and electrolyte balance, supplement nutrition, and strengthen supportive therapy, such as blood transfusion, etc. 5.The application of hormones is not consistent, and the use of hormones alone is prohibited. Because hormones can lead to immunosuppression, the use of hormones alone is not beneficial, but harmful. But some people advocate the early application of antibiotics at the same time can be combined with hormones, in order to reduce the role of bacterial toxins. 6, local should use non-irritating antiseptic, such as 0.5% to 1% neomycin emulsion for external use. It is best to remove the herpetic membrane, then use 1:5000 ~ 1:10000 potassium permanganate solution or 1:2000 safranin solution wet compress, clean change with 1% gentian violet solution rubbing, etc.