This is a severe acute generalized exfoliative pustulosis occurring in newborns and is characterized by the development of flaccid scald-like blisters and large areas of epidermal exfoliation over a generalized erythematous base. It is occasionally seen in adults. [Etiology] This disease is a serious skin infection mainly caused by coagulase-positive phage II group 71 Staphylococcus aureus. This type of staphylococcus can produce epidermolysis bullosa toxin, causing skin damage. Now it is found that some staphylococci of group I or group III can also produce epidermolysis bullosa toxin. It has been shown that Epidermolysis bullosa toxin is mainly excreted by the kidneys. In infants and young children, excretion is very slow, and this toxin increases in the serum and causes skin damage and peeling. Staphylococcal scalded skin-like syndrome occurring in adults is often seen in people with nephritis, uremia, debility, immune deficiency, or severe staphylococcal sepsis, and may be related to renal excretion and low immune function. Tian Peichao, Department of Pediatric Internal Medicine, First Affiliated Hospital of Zhengzhou University [Pathological changes] The histopathology of this disease is keratinization insufficiency, the stratum corneum may be reticulate, the echinocyte layer is edematous, the echinocytes undergo vacuolation and nuclear condensation, and there is a gap between the stratum corneum and the echinocyte layer. The dermis is edematous and congested, and there is a medium-high inflammatory infiltrate around blood vessels. Clinical manifestations] The beginning of the damage can occur in any part, but often start from the face, especially the perioral or neck, local skin redness, rapidly expanding to the surrounding, in two or three days the whole body skin can be red, in the erythema on the base of the blisters of varying sizes. The blisters appear on the base of the erythema in varying sizes and can merge with each other to form larger blisters. Tenderness is obvious, the wall of the blister is thin, loose and easy to break, Niehl’s sign is positive, the epidermis is very easy to peel off, revealing a bright red moist surface, quite similar to scald-like. The blister fluid is plasma, can also be turbid like pustulosis, blister fluid bacterial culture common staphylococcus aureus, streptococcus or hemolytic streptococcus. Facial involvement can be seen as light yellow scabs, perioral radial cracks, the head is rarely invaded. The oral cavity, nasal mucosa, conjunctiva can be involved, the appearance of inflammation, rhinitis and corneal ulcers. Patients are often accompanied by systemic symptoms such as fever and diarrhea. Some die due to secondary bronchopneumonia, sepsis, abscess or gangrene, etc., mostly in infants and young children, after a sharp, high mortality rate. Differential diagnosis] 1, falling flaky erythroderma: damage for diffuse redness, the surface with a large number of furfuraceous scales, no pustules and vesicles, scalp, eyebrows, limbs flexion side of seborrheic dermatitis changes, the course of the disease is chronic, the use of a sufficient amount of antibiotic treatment is ineffective. 2, neonatal pustulosis: some clinical manifestations and the disease is similar, some people think it may be the same disease isotypes. However, neonatal pustulosis is dominated by pustules, does not form generalized erythroderma, Niehl’s sign is negative, no epidermolysis bullosa, often within half a month of birth. 3, non-golden grape type toxic epidermal necrolysis and laxity: distinguish between gold Portuguese type and non-golden Portuguese type is very important, because the two treatments are different, the prognosis is not the same, non-golden Portuguese type is caused by most of the drugs, and this part of the patient is actually the type of drug measles, mainly in adults, lesions polymorphic, like polydisplay erythema, Niebuhr’s sign is only positive at the lesions; and gold Portuguese type of appearance of the unimpaired skin, Niebuhr’s sign is also positive. The pathologic changes are also different. Non-golden Portuguese type epidermal necrosis of the whole layer, subepidermal blisters; while the golden Portuguese type of superficial epidermal necrosis, intraepidermal blisters. 【Diagnosis】According to the rapid onset of the disease, extensive erythema of the skin, flaccid blisters, epidermal exfoliation, Nee’s sign is positive, and most of them occur in infants and young children and other characteristics can be diagnosed. [Treatment measures] 1, pay attention to the baby’s cleanliness and hygiene, diapers should be clean, with purulent skin disease of health care workers or family members are not allowed to contact with the newborn. 2.Strengthen nursing care, pay attention to keep warm. Pay attention to oral and eye care. 3.Early should use a sufficient amount of effective antibiotics, in order to remove the presence of the body of the Aureus infection foci, terminate the production of bacterial toxins. And make antibiotic sensitivity test, in order to choose suitable antibiotics. Can give methicillin, adults for 1 ~ 1.5g, intramuscular injection every 4 ~ 6 hours, children according to the daily per kilogram of body weight 150 ~ 250mg, divided into 4 times intramuscular injection. Or give erythromycin at a dose of 80 mg/(kg・d) intravenously. For penicillinase-resistant strains, vancomycin V, o-chloropenicillin can be used, and other second or third generation cephalosporins can also be used. 4, pay attention to water, electrolyte balance, supplemental nutrition, strengthen the supportive therapy, such as blood transfusion. 5, about the application of hormone opinions differ, prohibit the use of hormone alone. Because hormones can lead to immunosuppression, the use of separate but not beneficial, but harmful. However, some people also advocate the early application of antibiotics at the same time can be combined with the use of hormones, in order to reduce the role of bacterial toxins. It is difficult to determine the cause and diagnosis of the patient, antibiotics and hormones can be used in combination, once it is clear that the TEN is aureus type, hormone therapy should be discontinued immediately. 6, local should use non-irritating bactericides, such as 0.5% ~ 1% neomycin emulsion for external use. Large blister blister membrane is best removed, and then 1:5000 ~ 1:10000 potassium permanganate solution or 1:2000 xanthin solution wet compresses, clean and change the medicine with 1% gentian violet solution rubbed and so on.