Diagnostic dilemma: extremely low birth weight baby with staphylococcal scalded-skin syndrome or toxic epidermal necrolysis.

Exfoliative skin diseases of the neonate are relatively rare but when present require rapid diagnosis and treatment to decrease morbidity and mortality associated with these entities. We present the case of a 795 g premature male infant who developed exfoliative lesions on day of life 66. Skin and blood cultures were obtained and intravenous antibiotics initiated. Results of a Tzanck smear suggested toxic epidermal necrolysis (TEN), so the infant was emergently transferred to a local children's hospital with burn unit capabilities for further care. Further histopathological evaluation of the skin biopsy confirmed the diagnosis of staphylococcal scalded-skin syndrome (SSSS). The desquamation ceased 24 h after the initiation of antibiotic therapy, and the skin lesions resolved within 10 days. We discuss the pathogenesis of SSSS and TEN and highlight the importance of early diagnosis so appropriate treatment can be initiated.