Life Threatening Skin Rash series – Toxic Shock Syndrome

Toxic shock syndrome eczema

Picture taken from http://www.healthline.com/health/toxic-shock-syndrome#Overview1

Toxic shock syndrome is rare but life threatening, caused by bacterial toxins from staphylococcus aureus. Toxic Shock Syndrome commonly affects teens and young adults, from age 15 to 35 and majority, female.

What Causes Toxic Shock Syndrome?

Toxic Shock Syndrome is due the bacterial infection via the skin, vagina or pharynx into the bloodstream. While it is not uncommon for Staph bacteria to colonize the skin, a cut, surgery or wound in some individuals may lead to the bacteria entering the blood without immunity to fight it. The conducive environment for the toxin is protein-rich and oxygen, which is what the use of tampons during menstruation provides. Tampons with higher absorbency (polyester, carboxymethylcellulose and polyacrylate) increases the risk of TSS. The toxins can cross the vaginal wall to the blood stream, possibly through tear when inserting the tampon.

Symptoms of Toxic Shock Syndrome

  • Flu-like symptoms
  • Confusion, dizziness due to low blood pressure
  • Skin rash
  • Swelling and redness in mucous membrane
  • Shock
  • Multi-organ failure

Diagnosis is made based on physical examination, blood or urine test or swaps from the cervix, vagina and throat.

Stages of Toxic Shock Syndrome

  1. High fever, sore throat, fatigue, muscle ache, nausea, fatigue, diarrhea, headache, dizziness (low blood pressure), confusion
  2. Reddish tongue, inflamed mucous membrane (eyes)
  3. Swelling of joints and eyelids
  4. Skin rash – generalized, flat and red (characterized by turning white when pressed)
  5. Shock occurs when the blood pressure cannot be maintained
  6. Skin rash disappears on recovery.
  7. Skin on palms of hands and soles of feet flake and peel off.
  8. Fingernails, toenails and hair may fall out.

Types of Toxic Shock Syndrome

  • Toxic Shock Syndrome due to bacteria Staphylococcus aureus
  • Streptococcal Toxic Shock Syndrome due to bacteria Streptococcus pyogenes

Treatment of Toxic Shock Syndrome

TSS is considered a medical emergency that required hospitalisation. An intravenous antibiotic will be prescribed to fight the bacteria infection, or medication to stabilize blood pressure and to prevent dehydration. Injections may also be given to suppress inflammation and increase body’s immunity. Also the cause of the bacterial infection will be removed, for instance, removal of the tampon or draining pus from the skin wound.

Complications of Toxic Shock Syndrome

If the internal organs are affected, it can lead to liver, kidney, heart failure, seizure and shock. Early detection of toxic shock syndrome has a much higher chance of recovery. The mortality rate is about 5-15% and rate of recurrence at 30-40%.

Toxic Shock Syndrome and Eczema

It is observed that patients recovering from TSS tend to develop chronic eczema. I couldn’t find literature on the likelihood of having TSS if one has eczema. I wonder if there’s increased risk since the skin of eczema patients tend to have staph bacteria colonization.

Prevention of Toxic Shock Syndrome

Certain precautions for menstruating female who uses tampon are to change the tampon every 4 to 8 hours and to use a low-absorbency tampon. Wash hands and keep skin cuts and wounds clean with frequent dressing change. TSS may recur, thus tampon should not be worn by those who had TSS before.

Anyone have experience with toxic shock syndrome? Do share, it will be useful to the rest of us and to be more aware of the risks.

For other life-threatening skin rash, see below:

Stevens Johnson Syndrome

Pemphigus Vulgaris

Staphylococcal Scalded Skin Syndrome

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