Dermoscopy Helps Differentiate Staph Scalded Skin Syndrome from TEN

HealthDay News — Dermoscopy can differentiate staphylococcal scalded skin syndrome (SSSS) from toxic epidermal necrolysis (TEN), according to a letter to the editor published online in the Journal of Dermatology.

Kazuya Miyashita, from the Nara Medical University School of Medicine in Kashihara, Japan, and colleagues describe the case of a 77-year-old man with SSSS. The patient presented with subcutaneous masses in the right groin arising from the lymph nodes, which were diagnosed as diffuse large B-cell lymphoma.

The authors note that the patient was administered celecoxib due to pain at the biopsy site at day seven after biopsy. Five days later he was hospitalized with a fever and erythroderma. After the skin lesions extended to all over the body, followed by exfoliation, he was suspected to have TEN. A fresh exfoliation site on the trunk, which still had an epidermis with less leachate, was identified with dermoscopy, indicating subcorneal detachment. A skin biopsy revealed subcorneal cleavage without epidermal necrosis, which was consistent with late SSSS, but not TEN. 

Methicillin-susceptible Staphylococcus aureus was isolated from turbid adipose tissue around the inguinal lymph node. Intravenous administration of vancomycin hydrochloride and meropenem hydrate was started on the day of admission; seven days later the patient had recovered and had improved skin findings.

“We suggest dermoscopy as a tool for quickly diagnosing SSSS and enabling the faster initiation of appropriate therapies,” the authors write.


1. Miyashita K, Ogawa K, Ilioka H, et al. Adult case of staphylococcal scalded skin syndrome differentiated from toxic epidermal necrolysis with the aid of dermoscopy. J Derm. 2016;DOI: 10.1111/1346-8138.13281.