A Multicenter Review of Toxic Epidermal Necrolysis Treated in U.S. Burn Centers at the End of the Twentieth Century

Abstract

Toxic epidermal necrolysis (TEN) is a potentially fatal disorder that involves large areas of skin desquamation. Patients with TEN are often referred to burn centers for expert wound management and comprehensive care. The purpose of this study was to define the presenting characteristics and treatment of TEN before and after admission to regional burn centers and to evaluate the efficacy of burn center treatment for this disorder. A retrospective multicenter chart review was completed for patients admitted with TEN to 15 burn centers from 1995 to 2000. Charts were reviewed for patient characteristics, non-burn hospital and burn center treatment, and outcome. A total of 199 patients were admitted. Patients had a mean age of 47 years, mean 67.7% total body surface area skin slough, and mean Acute Physiology and Chronic Health Evaluation (APACHE II) score of 10. Sixty-four patients died, for a mortality rate of 32%. Mortality increased to 51% for patients transferred to a burn center more than one week after onset of disease. Burn centers and non-burn hospitals differed in their use of enteral nutrition (70 vs 12%, respectively, P < 0.05), prophylactic antibiotics (22 vs 37.9%, P < 0.05), corticosteroid use (22 vs 51%, P < 0.05), and wound management. Age, body surface area involvement, APACHE II score, complications, and parenteral nutrition before transfer correlated with increased mortality. The treatment of TEN differs markedly between burn centers and non-burn centers. Early transport to a burn unit is warranted to improve patient outcome.

A 19-Year Old Female with Toxic Epidermal Necrolysis and Acute Pulmonary Failure was Successfully Treated with Extracorporeal Membrane Oxygenation: A Case Report and Review of the Literature

“…In over 50% of all patients diagnosed with TEN, treated at a burn centre, the eyes are affected [6][7][8]. In our patient, the eyes and the respiratory tract were severely affected.…”

Dress Syndrome Due to Ciprofloxacin Use: Case Report

“…13,14 However, as it has been emphasized in the literature that scarce number of burn units, we had to treat our patient in our clinic after preparing a sterile environment because of unavailability of burn unit.…”

Stevens-Johnson Syndrome after Treatment of Female Patient with Small Lymphocytic B-Cell Lymphoma, Autoimmune Hemolytic Anemia and Antiphospholipid Antibody Syndrome with Rituximab

“…Синдром Стивенса-Джонсона представляет собой острую реакцию на лекарственный препарат и характеризуется острым развитием эрозий на слизистой оболочке ротовой полости и некроза кожи. Он быстро прогрессирует и при отсутствии терапии приводит к смерти [31]. Клиническая картина и течение заболевания согла-суются с диагнозом «синдром Стивенса-Джонсона».…”