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The importance of early recognition and treatment of skin lesions on the stumps of amputees cannot be overemphasized. Heavy demands are placed on the stump skin by the artificial limb. Even a minor skin eruption may, through neglect or mistreatment, become an extensive disorder that will seriously threaten the amputee's mental, social, and economic rehabilitation. Contact dermatitis, eczemas, epidermoid cysts, bacterial and fungus infections, chronic ulcers, and verrucose hyperplasia are among the disorders to which the stump skin is subject. Proper stump hygiene is often effective in alleviating or averting some of these conditions. Since skin disorders in amputees are essentially “environmental” dermatoses, their treatment often involves change of the environment through adjustment or redesign of the artificial limb. For example, verrucose hyperplasia was treated successfully by a change in prosthetic design. Thus, the skills of engineers and prosthetists must be combined with the contributions of dermatologists and other medical specialists in the solution of skin problems of the amputee.

The localized form of staphylococcal scalded skin syndrome, bullous impetigo, occurs commonly in children but rarely in adults. We will describe a case of bullous impetigo in an adult which developed while the patient was receiving short-term therapy with orally administered corticosteriods. Scalded skin syndrome in this case was characterized by isolation of phage group 2 staphylococci from intact bullae and by the presence of an intraepidermal, subgranular cleavage plane in histological sections. Features that differentiate the localized form of scalded skin syndrome from generalized forms include the presence of dermal infiltrate and the absence of cutaneous erythema and tenderness. On the basis of available experimental evidence, the rarity of both localized and generalized scalded skin syndrome in adults can be attributed to immunologic competence or enhanced capacity of adults to metabolize the staphylococcal exfoliatin.

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