Highlights
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Neonate presented with skin scaling and erythema suggestive of congenital ichthyosis.
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Clinical features included ectropion, eclabium, and a positive Nikolsky sign.
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A diagnosis of SSSS superimposed on congenital ichthyosis was made clinically.
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Multidisciplinary care led to skin re-epithelialization and symptom resolution.
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Ichthyotic changes persisted despite recovery from acute SSSS episode.
Keywords: Staphylococcus, Scalded skin syndrome, Neonate, Undernutrition, Ichthyosis, Ectropion
Medical imagery
A 1-month-old female neonate, born at term via spontaneous vaginal delivery presented with thin, yellowish skin scaling at birth and was initially treated for suspected sepsis. Pregnancy was uncomplicated. Worsening desquamation led to readmission, where she exhibited fever, widespread erythema, and skin peeling with ectropion and eclabium at day 42 of life, Fig. 1. Examination showed a parchment-like appearance with a positive Nikolsky sign and moderate wasting, but mucous membranes were spared. A clinical diagnosis of staphylococcal scalded skin syndrome (SSSS) superimposed on congenital ichthyosis was made. Comprehensive care included intravenous antibiotics, supportive management, emollients, oral acitretin, and nutritional support. Over three weeks, the infant showed significant clinical improvement with skin re-epithelialization and resolution of systemic symptoms at day 70 of life, though ichthyotic changes persisted. Blood cultures were negative and skin biopsy was not done. SSSS is a toxin-mediated dermatologic emergency predominantly affecting neonates and young children [1]. It results from exfoliative toxins produced by Staphylococcus aureus, leading to widespread epidermal detachment [2]. A study from Uganda showed that about 15 % of Uganda women in labour have vaginal colonisation with S. aureus, predisposing their babies to SSSS [3]. Congenital ichthyosis encompasses a group of hereditary disorders characterized by abnormal epidermal differentiation, often presenting with scaling and hyperkeratosis [4]. SSSS can complicate congenital ichthyosis syndromes such as Netherton syndrome [5]
Fig. 1.
Clinical progression of collodion membrane shedding and facial feature improvement in an infant. (A–B) Initial presentation at day 42 of life, showing marked ectropion, eclabium, and restricted joint mobility. (C–D) After three weeks of hospitalization, at day 70 of life, demonstrating gradual shedding of the collodion membrane, reduction of ectropion and eclabium, and progressive skin re-epithelialization.
CRediT authorship contribution statement
Monica Lillian Nakyeyune: Writing – review & editing, Writing – original draft, Visualization, Validation, Resources, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization. Felix Bongomin: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Software, Resources, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization.
Author contributions
Monica Lillian Nakyeyune and Felix Bongomin: Conceptualization, data curation, writing—original draft, writing—review and editing. Felix Bongomin: Supervision.
Informed consent
Written informed consent was obtained from the mother of the neonate for publication of this case report and the accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.
Ethical Approval
This work was performed in accordance with the tenets of the Declaration of Helsinki and its amendments, and the Ethical Guidelines for Clinical Research from Uganda National Council for Science and Technology.
Funding Source
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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