What sign is observed in cases of Staphylococcal scalded skin syndrome?

Staphylococcal scalded skin syndrome (SSSS) is a condition primarily caused by certain strains of Staphylococcus aureus that produce exfoliative toxins. One of the hallmark signs observed in SSSS is the presence of Nikolsky sign, which is characterized by the epidermis slipping off easily when slight lateral pressure is applied to the skin. This is due to the disruption of the connections between the keratinocytes, leading to a superficial separation of the epidermis from the dermis.

In SSSS, this sign becomes evident as the disease progresses, particularly in young children and neonates, who are more susceptible to the effects of these toxins. The presence of Nikolsky sign indicates the integrity of the epidermis is compromised, reflecting the pathophysiological effects of the exfoliative toxins.

While bullae formation and rapid spread of rash can be associated with various skin conditions, it is the Nikolsky sign that specifically indicates the epidermal fragility due to the action of the exfoliative toxins in Staphylococcal scalded skin syndrome. Fever and chills may accompany the infection but are not diagnostic signs of SSSS itself.