title: A case report of differentiating staphylococcal scalded skin syndrome and toxic epidermal necrolysis by optical coherence tomography.
abstract: BACKGROUND
  Staphylococcal scalded skin syndrome (SSSS) and toxic epidermal necrolysis (TEN) both present with acute onset, high morbidity and significant mortality. Rapid diagnosis is therefore of importance. The aim of this study was to investigate and compare the presentation of these diseases using optical coherence tomography (OCT).
  
  
  METHODS
  Two male patients with bullous diseases, SSSS and TEN, respectively, were photographed digitally, examined using dermoscopy, OCT scanned and subsequently biopsied in the said order.
  
  
  RESULTS
  The bullous skin was visualized by OCT showing two distinct images: the SSSS-patient displayed superficial hyporefletive flaccid structures with a split high in the thickened (0.51 mm vs. 0.12 mm) epidermis while the TEN-patient demonstrated a larger hyporeflective ovoid structure with a split right below the thickened epidermis (0.18 mm vs. 0.06 mm).
  
  
  CONCLUSIONS
  These findings suggest that there is a potential for the application of OCT scanning in the acute phase of SSSS and TEN in order to distinguish them for a faster diagnosis and better management and treatment.
authors.affiliation: Department of Dermatology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark.
authors.forename: A A
authors.initials: AA
authors.lastname: Hussain
authors.affiliation: Department of Dermatology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark.
authors.forename: C A
authors.initials: CA
authors.lastname: Banzhaf
authors.affiliation: Department of Dermatology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Themstrup
authors.affiliation: Department of Pathology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark.
authors.forename: P L
authors.initials: PL
authors.lastname: Nielsen
authors.affiliation: Department of Dermatology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark.
authors.forename: G B E
authors.initials: GB
authors.lastname: Jemec
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000473:pathology*; D013206:Staphylococcal Scalded Skin Syndrome / Q000473:pathology*; D013262:Stevens-Johnson Syndrome / Q000473:pathology*; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: Staphylococcal scalded skin syndrome; diagnostic imaging; optical coherence tomography; skin imaging; toxic epidermal necrolysis