Differential Diagnosis for Distinguishing between Toxic Epidermal Necrolysis and Staphylococcal Scalding Skin Syndrome
- Single most likely diagnosis:
- Level of exfoliation (c): The primary distinction between toxic epidermal necrolysis (TEN) and staphylococcal scalding skin syndrome (SSSS) lies in the level of skin exfoliation. TEN is characterized by full-thickness epidermal necrosis leading to widespread skin detachment, whereas SSSS involves a more superficial cleavage within the epidermis, typically above the granular layer, resulting in less severe exfoliation.
- Other Likely diagnoses:
- Bullae formation (b): While both conditions can present with bullae, the nature and distribution can help differentiate them. TEN tends to have more widespread and deeper bullae, whereas SSSS has more superficial and localized bullae, often starting in the face and spreading downwards.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Response to steroid (d): Although not the most reliable method for differentiation, the response to treatment, including steroids, can be critical. TEN may show some improvement with steroid treatment, but the primary approach is supportive care and withdrawal of the offending drug. SSSS, being caused by staphylococcal toxins, may not respond directly to steroids but requires antibiotic treatment.
- Rare diagnoses:
- Degree of erythema (a): While the degree of erythema can vary in both conditions, it is not a reliable distinguishing feature. Both TEN and SSSS can present with significant erythema, making this a less useful criterion for differentiation. Other rare conditions that might mimic these diseases, such as autoimmune bullous diseases or drug-induced eruptions, would require specific diagnostic tests for identification.