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Cutaneous T cell lymphoma

Specifically Sézary syndrome, can cause erythroderma but is a chronic malignancy in adults with severe pruritus, not an acute, toxin-mediated blistering illness in children.

DRESS syndrome

A drug reaction with fever and erythroderma, but is distinguished by a later onset (2-8 weeks post-drug), eosinophilia, and internal organ involvement, without widespread sloughing.

Drug reaction

Can cause erythroderma but typically lacks the tender skin, positive Nikolsky sign, and periorificial crusting seen in SSSS.

Kawasaki disease

An acute vasculitis in children with fever and rash, but is defined by conjunctivitis, mucosal changes, and lymphadenopathy, not superficial skin sloughing.

Pustular psoriasis

Presents with lakes of pus and is not associated with the large-scale epidermal peeling or positive Nikolsky sign of SSSS.

Scarlet fever

Features a sandpaper-like rash and 'strawberry tongue' but does not cause the blistering or epidermal separation characteristic of SSSS.

Sunburn

Severe sunburn can blister, but is limited to sun-exposed areas and is preceded by significant UV exposure, not a bacterial infection.

Toxic epidermal necrolysis

Also features widespread blistering and sloughing, but involves full-thickness epidermal necrosis (deeper cleavage plane) and severe mucosal involvement, typically drug-induced in adults.

Toxic shock syndrome

Presents with fever, hypotension, and multi-organ dysfunction, with a diffuse macular erythroderma that later desquamates, but lacks the initial blistering phase of SSSS.

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