Ritter von Ritterschein Disease

Way back June 2010, it was the crucial moment in our family when my son was confined in the hospital. It was a hearth breaking for us seeing our only baby boy suffering a kind of disease. His skin  looks like it was burnt in a fire. We can't even afford to hold and carry him because he will feel the pain in his body. What my son experienced was a kind of skin disease that mostly susceptible on infants up to 2yrs old kids. My son was diagnosed for almost 1 week in the hospital. It was started with watery redness around his mouth and about a minute, the bacteria scattered so fast all over his face and body. This skin disease is called Staphylococcal scalded skin syndrome (SSSS), also known as Ritter von Ritterschein disease (in newborns), Ritter disease, and staphylococcal epidermal necrolysis, encompasses a spectrum of superficial blistering skin disorders caused by the exfoliative toxins of some strains of Staphylococcus aureus.

It is a syndrome of acute exfoliation of the skin typically following an erythematous cellulitis. Severity of staphylococcal scalded skin syndrome varies from a few blisters localized to the site of infection to a severe exfoliation affecting almost the entire body.

 As the syndrome evolves, an initial infection occurs, commonly at a site such as the oral or nasal cavities, throat, or umbilicus. Epidermolytic toxins are produced by the infecting Staphylococcus species; these toxins act at a remote site leading to a red rash and separation of the epidermis beneath the granular cell layer. Bullae form, and diffuse sheetlike desquamation occurs.

Staphylococcal scalded skin syndrome (SSSS) is most common in children and neonates. Staphylococcal scalded skin syndrome is rarer in adults, but it has been described in adults with renal failure, immunologic deficiency, and other chronic illness.

Children are more at risk because of lack of immunity and immature renal clearance capability (exfoliative toxins are renally excreted). Maternal antibodies transferred to infants in breastmilk are thought to be partially protective, but neonatal disease can still occur possibly as a result of inadequate immunity or immature renal clearance of exotoxin.

His ears is bleeding because of the bacteria. It came to a point that he can't open his eyes because of the infections but the good part is, inside his eyes was not affected only in his eyes' outer skin.

 (SSS Syndrome) almost always affects on most children (62%) are younger than 2 years, and almost all (98%) are younger than 6 years. SSSS is rare in adults, with fewer than 50 cases formally reported in the literature. Adults with SSSS are most often chronically ill, are immunocompromised, or have renal failure. SSSS can also appear in adults in cases with a high burden of staphylococcal infection where the quantity of exotoxin is significant. There is also a case report of SSSS in an adult after tooth extraction.

Staphylococcal scalded skin syndrome (SSSS) presents as a red rash followed by diffuse epidermal exfoliation. A prodromal localized S aureus infection of the skin, throat, nose, mouth, umbilicus, or GI tract occurs. Such an infection often is not apparent before the SSSS rash appears.

The following may be noted (Physical):                     

• General malaise
• Fever
• Irritability
• Skin tenderness
• Fever, although patients may be afebrile
• Tenderness to palpation
• Warmth to palpation
• Facial edema
• Perioral crusting
• Most patients do not appear severely ill.
• Dehydration may be present and significant.
• Nikolsky sign (gentle stroking of the skin causes the skin to separate at the epidermis).                  

Good thing, my sons appetite was not affected. He still continue drinking his milk. He had 3 specialist (pediatrician, dermatologist and eye doctor) collaborating about his condition. 

With the help of IV antibiotics and some liquid medicines, Physiogel Cleanser & cream, Cetaphil bar, and eye drops, my baby boy gets well after a week of suffering much pain. And of course with our tender loving care, tears and prayer, his skin regain to normal. 

After 1 week of battling for his fast recovery, I am so thankful that slowly my baby's skin was back to smoothness. 

Look at his lips, you can't see anymore the signs of what my baby has been through. Always make sure that the surroundings around your baby is always clean, to avoid any bacteria that will attack your baby. This time I will be very careful on anything & everything I do when it comes to my children, I don't want all this things will happened again.

Stay clean and safe Fellas! =)