Development of scalded skin syndrome in an adult patient with acquired epidermolysis bullosa after long-term treatment with methotrexate

Abstract

A clinical case of a patient with epidermolysis bullosa acquisita, which is a rare autoimmune disease ― 0.17–0.26 cases per 1 million population, with the development, most likely against the background of long-term cytostatic therapy with methotrexate, develops staphylococcal scalded skin syndrome is presented.

Staphylococcal scalded skin syndrome is a lesion that appears in 0.09–0.56 cases per 1 million and is predominantly observed in newborns and children under 5 years of age, and cases in adults are usually associated with immunosuppression, human immunodeficiency virus / acquired immunodeficiency syndrome, severe renal failure or malignant neoplasms.

The article presents literature data on the etiology and pathogenesis of the presented diseases, features of differential diagnosis, description of clinical and laboratory criteria, on the basis of which diagnoses are made.

This clinical case is of interest to dermatologists, as it describes the scalded skin syndrome, which is rare in everyday practice, in a patient with acquired epidermolysis bullosa, which, despite ongoing therapy, has a risk of death of up to 65%.

Keywords

Staphylococcal scalded skin syndrome / epidermolysis bullosa acquisita / Staphylococcus aureus / Lyell's syndrome / methotrexate

References

[1] Dermatovenerology. National leadership. Short edition. Ed. by Yu.S. Butov, Yu.K. Skripkin, O.L. Ivanov. Moscow: GEOTAR-Media; 2020. 896 p. (In Russ).

[2] Дерматовенерология. Национальное руководство. Краткое издание / под ред. Ю.С. Бутова, Ю.К. Скрипкина, О.Л. Иванова. Москва: ГЭОТАР-Медиа, 2020.896 с.

[3] Goldsmith LA, Katz SI, Gilchrist BA, et al. Fitzpatrick’s dermatology in clinical practice. Ed. by N.N. Potekaev, A.N. Lvov. Transl. from English A.V. Mishchenko, et al. 2nd revised and updated. Moscow: Panfilov Publishing House; 2018. (In Russ).

[4] Голдсмит Л.А., Кац С.И., Джилкрест Б.А., и др. Дерматология Фицпатрика в клинической практике. В 3 т. / под общ. ред. Н.Н. Потекаева, А.Н. Львова. Пер. с англ. А.В. Миченко и др. Изд. 2-е, исп., перер., доп. Москва: Издательство Панфилова, 2018.

[5] Handler MZ, Schwartz RA. Staphylococcal scalded skin syndrome: Diagnosis and management in children and adults. J Eur Acad Dermatol Venereol. 2014;28(11):1418–1423. doi: 10.1111/jdv.12541

[6] Handler M.Z., Schwartz R.A. Staphylococcal scalded skin syndrome: Diagnosis and management in children and adults // J Eur Acad Dermatol Venereol. 2014. Vol. 28, N 11. Р. 1418–1423. doi: 10.1111/jdv.12541

[7] Liy-Wong C, Pope E, Weinstein M, Lara-Corrales I. Staphylococcal scalded skin syndrome: An epidemiological and clinical review of 84 cases. Pediatr Dermatol. 2021;38(1):149–153. doi: 10.1111/pde.14470

[8] Liy-Wong C., Pope E., Weinstein M., Lara-Corrales I. Staphylococcal scalded skin syndrome: An epidemiological and clinical review of 84 cases // Pediatr Dermatol. 2021. Vol. 38, N 1. Р. 149–153. doi: 10.1111/pde.14470

[9] Zaslavsky DV, Ravodin RA, Tatarskaya OB, et al. Erythroderma: Current issues of diagnosis and treatment. Pediatr. 2014;5(1):97–102. (In Russ). doi: 10.17816/PED5197-102

[10] Заславский Д.В., Раводин Р.А., Татарская О.Б., и др. Эритродермия: современные вопросы диагностики и лечения // Педиатр. 2014. Т. 5, № 1. С. 97–102. doi: 10.17816/PED5197-102

[11] Samtsov AV, Belousova IE. Bullous dermatoses. Saint Petersburg: Costa; 2012. 142 p. (In Russ).

[12] Самцов А.В., Белоусова И.Э. Буллезные дерматозы. Санкт-Петербург: Коста, 2012. 142 с.

[13] Miyamoto D, Gordilho JO, Santi CG, Porro AM. Epidermolysis bullosa acquisita. An Bras Dermatol. 2022;97(4):409–423. doi: 10.1016/j.abd.2021.09.010

[14] Miyamoto D., Gordilho J.O., Santi C.G., Porro A.M. Epidermolysis bullosa acquisita // An Bras Dermatol. 2022. Vol. 97, N 4. Р. 409–423. doi: 10.1016/j.abd.2021.09.010

[15] Koga H, Prost-Squarcioni C, Iwata H, et al. Epidermolysis bullosa acquisita: The 2019 update. Front Med (Lausanne). 2018;5:362. doi: 10.3389/fmed.2018.00362

[16] Koga H., Prost-Squarcioni C., Iwata H., et al. Epidermolysis bullosa acquisita: The 2019 update // Front Med (Lausanne). 2018. Vol. 5. Р. 362. doi: 10.3389/fmed.2018.00362

[17] Patel S, Cadwell JB, Lambert WC. Comparison of adult vs paediatric staphylococcal scalded skin syndrome inpatients: A retrospective database analysis? Br J Dermatol. 2021;184(4):767–769. doi: 10.1111/BJD.19691

[18] Patel S., Cadwell J.B., Lambert W.C. Comparison of adult vs paediatric staphylococcal scalded skin syndrome inpatients: A retrospective database analysis? // Br J Dermatol. 2021. Vol. 184, N 4. Р. 767–769. doi: 10.1111/BJD.19691

[19] Ross A, Shoff HW. Staphylococcal scalded skin syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.

[20] Ross A., Shoff H.W. Staphylococcal scalded skin syndrome // StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2022.

RIGHTS & PERMISSIONS

Eco-Vector