Ritter syndrome (Staphylococcal scalled skin syndrome (SSSS)) is a rare disease characterized by generalized dermatitis and epidermal discharge. It occurs most often in infants and young children up to 5 years of age. What are the causes and how is Ritter's syndrome treated?

Contents:

  1. Ritter's disease - causes
  2. Ritter's disease - symptoms
  3. Ritter's disease - differentiation
  4. Ritter's disease - diagnosis
  5. Ritter's disease - treatment

Ritter's diseaseis a rare dermatosis that primarily affects young children. Interestingly, this disease entity has many names - Ritter syndrome, Ritter-Lyell syndrome, staphylococcal exfoliative dermatitis (Latindermatitis bullosa et exfoliativa neonatorum ,dermatitis Ritter) and vesiculitis and exfoliative skin inflammation of newborns (Latinpemphigus neonatorum ).

When Ritter's disease affects the children of older adult patients and is accompanied by renal failure, medics refer to it as staphylococcal scalded-skin syndrome (SSSS).

Ritter's disease - causes

Ritter's disease is bacterial in origin.

Ritter's syndrome develops when the bacterium, Staphylococcus aureus, produces exfoliatin, which binds to desmoglein I in the superficial layers of the epidermis, leading to acantholysis, i.e. loss of cell connectivity in the epidermis.

Ritter's disease - symptoms

Staphylococcal burn skin syndrome(another name used in reference to this unit) is characterized by:

  • creeping of the epidermis
  • generalized dermatitis
  • erythema

The loss of the epidermis occurs as a result of the formation of flaccid, abortive blisters filled with serous fluid. They can arise in any part of the body.

The lesions even cover the entire surface of smooth skin, but they usually begin to appear around the mouth and in skin folds, for example in the armpits.

The disease does not affect the hairy scalp and mucous membranes of the digestive system, respiratory system, urinary system and the eye. Nevertheless, symptoms may appear around the skin of the eyelids and redlabial.

Patients have a fever, are irritable, complain of painful and burning skin.

Ritter's disease - differentiation

Ritter's syndrome should be differentiated by the following diseases:

  • Lyell's syndrome - toxic epidermal necrolysis, although the etiology is not fully understood, drugs are the most common cause. The disease occurs later than Ritter's syndrome, usually after the age of 40, and occurs in adults with immunodeficiency
  • Congenital blistering epidermal separation - EBH - changes may affect the respiratory and digestive epithelium, and are intensified at pressure points, for example caused by clothing. Unlike Ritter's syndrome, antibiotic treatment is unsuccessful and scars remain
  • Acquired bullous epidermal separation - EBA - concerns adults, isolated cases occur in children. The course is chronic, unlike SSSS, there is no fever or dermatitis in EBA
  • Chemical and thermal burns - an interview with the patient is of key importance, the doctor makes a diagnosis based on the information obtained about the circumstances of the blisters appearing
  • Kawasaki syndrome - characteristic symptoms include painful swelling of the hands and feet, high fever, severe general condition and lymphadenopathy

Ritter's disease - diagnosis

The diagnosis of SSSS is made on the basis of clinical symptoms and culture. In order to determine the source of infection, cultures should be taken from the eyes, nose, throat and blood tests. In order to perform a full diagnosis with less characteristic symptoms, it is recommended to phage typing of cultured staphylococci and histopathological examination of the skin section.

Ritter's disease - treatment

Antibiotic therapy should be initiated before the bacteriological test results. Empirical antibiotic therapy should be confirmed with an antibiogram, especially if S. aureus MRSA is cultured. Recommended antibiotics:

  • 1st and 2nd generation cephalosporins
  • clindamycin - inhibiting the production of toxins
  • cloxacillin

Additionally, painkillers should be administered as long as the symptoms persist. At the beginning, non-steroidal anti-inflammatory drugs are not recommended due to the possibility of bleeding from skin lesions.

It is worth remembering that staphylococcal toxin is secreted by the kidneys, so it is recommended to drink plenty of fluids to get rid of this disease factor. Children who are primarily affected by this disease are at particular risk of becoming dehydrated.

Dressings can be used as local treatmenthydrocolloid.

About the authorNatalia MłyńskaStudent of medicine at the Medical University of Lodz. Medicine is her greatest passion. He also loves sports, mainly running and dancing. She would like to treat her future patients in such a way as to see them as a human being, not only a disease.

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Category:

Dermatology