Exfoliative
skin diseases are rare in neonates. When caused by
coagulase-positive Staphylococcus aureus, scalded-
skin diseases such as
staphylococcal scalded-skin syndrome (SSSS), bullous
impetigo, and staphylococcal
scarlet fever may develop. These diseases might cause significant complications and mortality. SSSS is caused by staphylococcal
exfoliative toxins A or B, which split the granular layer of the skin, induce proteolysis, and might exhibit
superantigen activities, such as epidermolysis and lymphocyte mitogenicity. We describe a 1378-g premature male infant who was born at 29 weeks' gestation and developed SSSS on day 3 of life, with no clinical signs of
neonatal sepsis. After cultures from the lesion and bloodstream were obtained, intravenous
cloxacillin therapy was started. Infection control measures were implemented instantly and included isolation of the infected infant, personnel handwashing with
hexachlorophene, and placement of exposed neonates into a cohort. The initial lesion expanded and additional lesions appeared, but 12 hours after initiation of antibacterial
therapy, the lesions ceased to proliferate. Cultures from scalded-skin lesions grew
coagulase-positive Staphylococcus aureus, whereas the bloodstream culture was sterile. The lesions resolved completely within 6 days, and the infant's subsequent course was uneventful. No similar skin lesions were noticed in other infants in the neonatal intensive care unit. We discuss recent advances in understanding the pathogenesis of neonatal SSSS, highlight the importance of early diagnosis and treatment, and stress the need for new adjunctive
therapies for this disease.