Exfoliatin produced by Staphylococcus aureus is responsible for causing which condition?

• A. Enterocolitis
• B. Toxic shock syndrome
• C. Scalded skin syndrome
• D. Staphylococcal pneumonia

Answer: (C)

Exfoliatin from Staphylococcus aureus breaks the bonds that hold epidermal cells together in the outermost layers of the skin. These toxins act like proteases that cleave desmoglein-1 in the desmosomes of the stratum granulosum, causing the epidermis to separate and blister. The result is widespread, tender desquamation that gives the skin a scalded appearance, most common in neonates and young children who may lack circulating antibodies to neutralize the toxin. Mucous membranes are usually spared, and a positive Nikolsky sign can be seen. This condition is distinct from toxic shock syndrome, which is caused by a superantigen and presents with fever, hypotension, and organ involvement, and from enterocolitis or pneumonia, which are not caused by exfoliative toxins.