Epidermal necrolysis, the unifying term for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), is a severe cutaneous drug reaction associated with high morbidity and mortality. Given the rarity of this disease, large-scale prospective research studies are limited. Significant institutional and geographical variations in treatment practices highlight the need for standardization of clinical assessment scores and prioritization of research outcome measures in epidermal necrolysis. At the present, clinical assessment is typically simplified to total body surface area (BSA) involvement, with little focus on morphology. Validated clinical scoring systems are used as mortality prognostication tools, with SCORTEN being the best-validated tool thus far, although the ABCD-10 has also been recently introduced. These tools are imperfect in that they tend to either overestimate or underestimate mortality in certain populations and are not designed to monitor disease progression. Although mortality is often used as a primary endpoint for epidermal necrolysis studies, this outcome fails to capture more nuanced changes in skin disease such as arrest of disease progression while also lacking a validated skin-directed inclusion criterion to stratify patients based on the severity of skin disease at study entry. In addition to mortality, many studies also use BSA stabilization or time to re-epithelialization as endpoints, although these are not clearly defined morphologically, and inter- and intra-rater reliability are unclear. More specific, validated cutaneous assessment scores are necessary in order advance therapeutic options for epidermal necrolysis. In this review, we summarize the strengths and weaknesses of current clinical assessment practices in epidermal necrolysis and highlight the need for standardized research tools to monitor cutaneous involvement throughout the hospitalization.

report in conjunction with wound care and oral antibiotics. Suction may represent a less invasive and less painful alternative to surgical debridement. 1 Occlusive agents cause asphyxiation and emergence of maggots, allowing for subsequent mechanical removal. Ether followed by normal saline irrigation was described in one case report; there were no side effects reported and no evidence of local or systemic infection nor recurrence of maggots. 4 Turpentine oil was described in a similar fashion, but this treatment was associated with slower maggot shedding time and incomplete maggot resolution compared with administration of systemic therapy, ivermectin, along with mechanical extraction. 2 Among wound-cleansing agents, the effects of Dakin's solution (0.5% sodium hypochlorite), 70% isopropyl alcohol, povidone-iodine, and 3% hydrogen peroxide on maggot mortality were comparatively evaluated when applied daily to maggots in vitro for a total of 14 days. Maggot mortality among these solutions ranged between 33% and 46%, with Dakin's solution treatment associated with the highest mortality rate, suggesting the need for supplemental treatments to obtain complete clearance of wound myiasis. 5 The evidence to support a single most effective treatment strategy for wound myiasis is inconclusive. This case report presents a combination approach that demonstrated efficacy.There remains a need for additional studies to establish the comparative efficacy of treatment modalities and to develop standard guidelines for the management of wound myiasis.

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Asynchronous electronic consultations (e-consults) can be a useful tool for the screening of cutaneous lesions, but may offer a malpractice risk. We characterized factors affecting initial eConsult o ce followup in a cohort of patients with documented neoplasm of uncertain behavior.Patients with an ICD 10 code of neoplasm with uncertain behavior (D48.5) at The Ohio State University that received an E-consult order from May 2017 to May 2021 were queried. Information collected included patient demographics, status of follow-up in-o ce appointment, referral status, and health care utilization. In-o ce follow-up appointments were de ned as completed, cancelled/no-show or no-contact. 667 patients with a diagnosis of D48.5 were identi ed as having completed an eConsult. 427 (64%) patients had a documents phone/electronic message notifying the patient of the results of the eConsult.Year of encounter (0.88 [0.79-0.97]) and number of previously completed ambulatory visits (0.86 [0.77-0.96]) were signi cantly associated with documentation of phone/electronic message in the univariate and multivariate model. 429 (84%) patients had a dermatology o ce follow-up encounter while 82 (16%) had no appointment scheduled. Language spoken, referral status and race were signi cant in the univariate model, though race was the only signi cant variable in the multivariate model (p<0.003).Asynchronous electronic consults to assess possible cutaneous neoplasms is an important tool for population screening of skin cancer. Dermatologists and health systems implementing an eConsult model for screening purposes should be aware of risk factors for loss of follow-up. Additional systems need to be implemented to ensure minorities and non-native English speakers are obtaining adequate dermatologic care.