SAriesl pseonssien Erythema toxicum neonatorum Neonatal HSV Neonatal varicella Asymptomatic, scattered erythematous macules, papules & pustules throughout the body Three pattems e Vesicular clusters on skin, eyes & mucous membranes « Central nervous system infection * Fulminant, disseminated multi-organ disease Acyclovir Fever, ranges from vesicular clusters on skin to fulminant, Acyclovir disseminated disease Staphylococcal scalded skin syndrome Fever, irritability & diffuse erythema followed by blistering & exfoliation, positive Nikolsky's sign Oxacillin, nafcillin, or vancomycinThe healthy appearance of the neonate and the asymptomatic blotchy, erythematous papules and pustules support the diagnosis of erythema toxicum neonatorum (ETN). “Toxicum’ is a misnomer as the rash is benign and evanescent. Itis common in full-term neonates. The rash can change appearance and can occur on any part of the body (sparing the palms and soles) in the first 2 weeks of life. The etiology is unknown. Parents should be reassured that treatment is unnecessary as the rash resolves spontaneously without sequelae. Educational objective: Erythema toxicum neonatorum Is a benign neonatal rash characterized by blanching erythematous papules and/or pustules. It resolves spontaneously within 2 weeks after birth. ~ i 4Staphylococcal scalded skin syndrome (SSSS) is caused by exfoliative toxin-producing strains of S. aureus. The toxins target desmoglein 1, which is responsible for keratinocyte adhesion in the superficial epidermis. Usually there is a prodrome of fever, irritability, and skin tenderness. Erythema starts on the face, and generalizes within the ensuing 24-48 hours. Superficial flaccid blisters soon develop, with flexural accentuation and perioral crusting. The Nikolsky sign is positive (gentle lateral pressure on the skin surface adjacent to a blister causes slipping and detachment of a superficial layer of skin). The blisters of SSSS are fragile, and when unroofed reveal a moist erythematous base. Subsequent scaling and desquamation continue for about 5 days, and the entire process usually resolves within 1-2 weeks. Cultures from intact bullae are usually sterile, because this is a toxin-mediated process. The goal of treatment is to eliminate any inciting focus of infection with appropriate anti-staphylococcal antibiotics, and to provide supportive wound care of all denuded areas. SSSS is primarily a disease of children, but adults with renal disease or immunocompromise may also be affected. The mortality rate is low in pediatric patients, but can be quite high in adults. Staphylococcal scalded skin syndrome (SSSS) is caused by exfoliative toxin-producing strains of S. aureus. It starts with a prodrome of fever, irritability, and skin tenderness, which is followed by generalized erythema and superficial flaccid blisters with a positive Nikolsky sign. Scaling and desquamation follow, before resolution of the disease process. SSSS usually affects children below age 10, but adults with kidney disease or immune compromise may also be affected.