• | majority of patients <5 years old |
• | failure to adequately clear the toxin appears to predispose the very young (and those with renal failure) |
• | pathogen = phage group II, type 71 S. aureus colonizing "somewhere", but toxin mediated (therefore you probably won't culture it from a blister) |
• | exfoliative toxins A and B (ETA and ETB) |
• | may not act as superantigen |
• | postulated to cause blistering in the granular layer by directly binding desmoglein 1 |
• | an appropriate antibody response to ET appears to limit clinical disease expression to bullous impetigo; an inadequate response may predispose patients to development of SSSS |
• | accentuation in flexural areas, sterile blisters, |
• | very superficial (sub-corneal);Nikolsky’s sign |
• | intraoral lesions do not occur because of the absence of a granular layer to which the toxin may bind; however involvement of the keratinized external lip with crusting and fissuring is frequently encountered |
|