What is the diagnosis for a child presenting with fever, irritability, skin tenderness, followed by generalized erythema and superficial flaccid blisters with a positive Nikolsky sign?

The correct diagnosis for a child presenting with fever, irritability, skin tenderness, followed by generalized erythema and superficial flaccid blisters, accompanied by a positive Nikolsky sign, is Staphylococcal scalded skin syndrome (SSSS).

This condition, primarily caused by Staphylococcus aureus, involves the production of exfoliative toxins which lead to the separation of the epidermal layers, resulting in sensitive, blistering skin. The presence of generalized erythema and superficial blisters is characteristic, along with the positive Nikolsky sign, which indicates that the skin can be easily detached with slight pressure.

In contrast, chickenpox typically presents with a vesicular rash in various stages but does not typically exhibit the same level of tenderness or a positive Nikolsky sign. Impetigo is caused by bacterial infection but usually results in pustules and crusted lesions and does not lead to widespread blistering or the same presentation as SSSS. Scarlet fever, caused by Group A Streptococcus, features a distinctive rash and is generally associated with throat symptoms; however, it does not cause flaccid blisters or a positive Nikolsky sign.

These distinctions help confirm that Staphylococcal scalded skin