Differential Diagnosis for a Rash that Sloughs
Single Most Likely Diagnosis
- Staphylococcal Scalded Skin Syndrome (SSSS): This condition is caused by staphylococcal toxins that lead to the sloughing of the skin, particularly in infants and young children. It's a common cause of a rash that sloughs, especially in pediatric patients.
Other Likely Diagnoses
- Toxic Epidermal Necrolysis (TEN): A severe skin condition usually triggered by medications, leading to widespread skin necrosis and sloughing. It's a medical emergency.
- Steven-Johnson Syndrome (SJS): Similar to TEN but less severe, SJS is also often drug-induced and can cause skin sloughing along with mucosal involvement.
- Eczema Herpeticum: A complication of atopic dermatitis (eczema) where the skin becomes infected with the herpes simplex virus, leading to widespread vesicles that can slough.
Do Not Miss Diagnoses
- Necrotizing Fasciitis: A life-threatening infection that destroys the tissue under the skin, including fat and the tissue covering the muscles (fascia). Early signs can include a rash that may slough, along with severe pain and swelling.
- Toxic Shock Syndrome (TSS): A medical emergency caused by bacterial toxins, often associated with a rash, fever, and multi-organ failure. The rash can desquamate (slough) in the recovery phase.
- Meningococcemia: A severe infection caused by Neisseria meningitidis, which can present with a rash (petechiae or purpura) that may slough, along with signs of sepsis.
Rare Diagnoses
- Kawasaki Disease: An acute febrile illness of childhood that can cause a rash, desquamation (sloughing) of the skin in the subacute phase, and is associated with cardiac complications.
- Pemphigus Vulgaris: An autoimmune disease causing blistering of the skin and mucous membranes, which can lead to sloughing of the skin.
- Paraneoplastic Pemphigus: A rare autoimmune disorder associated with underlying neoplasia, characterized by severe blistering of the skin and mucous membranes that can slough.