Background Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous disorders. To date, relatively few studies have looked at institutional approaches to treatment of SJS/TEN, particularly with a focus on wound care. Methods A retrospective review was conducted on patients admitted to the Hennepin County Medical Center from 2007 to 2017 with a final diagnosis of SJS or TEN. Data were obtained for demographics, causative drug, hospital course, supportive care, medical management, complications, and disposition. Results A total of 48 were diagnosed with SJS/TEN during the study period. A total of 41.7% (20/48) were men, and the mean age was 49.2 years. Sulfa antibiotics and nonsulfa antibiotics were the most common causative drug categories, each accounting for a quarter of cases. Supportive measures included intravenous fluid resuscitation in 4.2% of cases, enteral nutrition in 75%, surgical debridement in 27.1%, and porcine xenograft in 16.7%. Wound care consisted of use of a cleanser in 95.8% of patients, topical antibiotic in 95.8%, topical steroid in 20.8%, topical antifungal in 14.6%, emollient in 83.3%, nonadherent dressing in 97.9%, silver impregnated dressing in 39.6%, nonsilver impregnated dressing in 79.2%, and general wrap in 93.8%. For medical treatment, 64.6% of patients received intravenous immunoglobulin (IVIG), and 8.3% of patients received cyclosporine. Mortality rate was 12.5% overall, compared to an expected mortality rate of 25.2% as predicted by SCORTEN. Conclusions Patients treated with our current regimen of care showed a mortality rate half of that predicted by SCORTEN.

The slime craze is all the rage among tweens. Slime is a homemade stretchy play material created by mixing together household items such as school glue, borax, shaving cream, and contact lens solution. We present a case of allergic contact dermatitis secondary to methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) in school glue used to make slime; mass spectroscopy confirmed MCI/MI in the patient's glue. Clinicians should be aware of slime as an emerging source of MCI/MI contact allergy.

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METHODSMinnesota State Fair attendees aged >18 years were invited to complete a 17-question, institutional review board-approved survey on essential oil (EO) use. The questionnaire was designed with input by experts in contact dermatitis (E.W. and S.H.) and survey methodology (N.G. and E.W.). RESULTSHalf of the approached individuals completed the survey. The characteristics of the 282 respondents are summarized in Table 1.Among EO users, the top EO-treated conditions included: musculoskeletal (50.5%), emotional (37.4%), upper respiratory (37.4%) and skin (28.0%) conditions. The reasons cited for EO use included: a desire for alternative treatments (53.4%), the opinion that EOs are safer than traditional therapies (47.6%), and/or failure of standard treatments (10.7%). Of the respondents, 54.5% reported diffusing EOs, and 30.3% incorporated EOs into homemade products ( Table 2). The frequency of specific EO use is shown in Table 3; other commonly used natural products included coconut oil (40.6%), aloe (29.2%), apple cider vinegar (28.3%), shea butter (26.4%), and vitamin E (20.8%).EOs were purchased from health cooperative/food stores (48.8%), family/friends (36.4%), or the internet (22.3%). Nine respondents (7.4%) sold EOs. Ten adverse reactions were reported by eight EO users (rash, n = 3; breathing difficulty, n = 2; burning sensation, n = 2; allergy, n = 2; and burning with urination after oral ingestion, n = 1). DISCUSSIONThis study has several key findings. First, we found that interest in natural products and use of EOs was high among all respondents (49.6% and 47.2%, respectively). Approximately one third (30.1%) of respondents reported using EOs within the last month. This rate of EO use is similar to that found in a general population study in France (34%). 1 Second, we found that EO use was statistically significantly associated with female sex, younger age, and higher education, but not race. EO use was also significantly associated with interest in natural/botanical products, and having close family members and close friends who are EO users. Third, many EO users treated medical conditions/symptoms (46.7%) with the EOs.The consumer EO market in the United States is largely composed of multilevel/networking marketing strategy companies (direct consumer sales via a hierarchy of individual distributors).