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Differentiating Staphylococcal Scalded Skin Syndrome (SSSS) and Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN)

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Feature	SSSS	SJS/TEN
Typical patient population	Infants, young children, and adults with kidney failure or immunocompromise	Older adults
Usual trigger	Recent staphylococcal infection (toxin-mediated)	Medication exposure (eg, antibiotics, antiseizure medications, NSAIDs)
Mucous membrane involvement	Absent	Present and prominent
Systemic illness	Mild to moderate	Severe, multisystem involvement
Level of epidermal cleavage*	Intraepidermal, within the granular cell (outermost) layer of the epidermis	Subepidermal, at or below the basal cell
Pathophysiology	Exfoliative toxins cause keratinocyte detachment	Immune-mediated keratinocyte apoptosis
* Level of epidermal cleavage is determined by frozen section of a fresh skin specimen.
NSAIDs = nonsteroidal anti-inflammatory drugs.