Bullous impetigo. Occurrence of localized scalded skin syndrome in an adult

P. M. Elias and S. W. Levy

The localized form of staphylococcal scalded skin syndrome, bullous impetigo, occurs commonly in children but rarely in adults. We will describe a case of bullous impetigo in an adult which developed while the patient was receiving short-term therapy with orally administered corticosteriods. Scalded skin syndrome in this case was characterized by isolation of phage group 2 staphylococci from intact bullae and by the presence of an intraepidermal, subgranular cleavage plane in histological sections. Features that differentiate the localized form of scalded skin syndrome from generalized forms include the presence of dermal infiltrate and the absence of cutaneous erythema and tenderness. On the basis of available experimental evidence, the rarity of both localized and generalized scalded skin syndrome in adults can be attributed to immunologic competence or enhanced capacity of adults to metabolize the staphylococcal exfoliatin.