A 62 year old woman of South East Asian origin who works as a housekeeper in Greece was admitted in the Emergency Department of a General Hospital in Athens Greece for fever, fatigue, deterioration of general health and a generalized rash that had appeared 2 days prior to admission. The patient had been taking isotretinoin at a dosage of 40mgr daily for 2 months for pityriasis rubra pilaris. Intolerance of glucose was reported with no medication prescribed the clinical examination revealed fever 39 °C hot tender red skin all over the body with widespread desquamation. The ocular, oral genital and anal mucosa were intact.

Thorax radiography was within normal limits. Hemocultures were positive for Staphylococcus Aureus. Also known as Ritter disease staphylococcal scalded skin syndrome is characterized by denudation of the skin caused by exotoxin producing strains of the Staphylococcus species typically from a distant site. It usually presents 48 hours after birth and is rare in children older than six years [1]. Treatment with systemic antibiotics results in resolution of the syndrome. Differential diagnosis is made with the Toxic epidermal necrolysis but in the latter the mucous membranes are always involved. Staphylococcal skin syndrome may also affect immunocompromised adults and those with renal insufficiency [2]. In the case reported dryness of the skin induced by the administration of isotretinoin has favored the colonization of the skin with Staphylococcus Aureus and in addition with the renal insufficiency that probably retarded the elimination of the exotoxin might have contributed to the development of Staphylococcal scalded skin syndrome. This case is reported to increase awareness of the rare occurrence of the syndrome in adult patients.

Keywords: Staphylococcal scalded skin syndrome; Adult; Isotretinoin