Rehabilitative Considerations for Patients with Severe Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis

McDonald, Kevin; Johnson, Brian B.; Prasad, J.K.; Thomson, Philip D.

doi:10.1097/00004630-198903000-00012

Cited by 5 publications

(3 citation statements)

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“…Once the patient is stable and conscious, a physical therapist should evaluate the patient daily for range of motion, mobility, strength, and endurance impairments. 91 Daily physical therapy should be initiated as early as possible to preserve limb mobility and improve strength of endurance, while limiting joint contractures.…”

Section: Physical and Occupational Therapymentioning

confidence: 99%

Multidisciplinary care in Stevens-Johnson syndrome

Shanbhag

Chodosh

Fathy

et al. 2020

Therapeutic Advances in Chronic Disease

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Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are potentially fatal mucocutaneous diseases that can involve many organ systems. Manifestations of SJS/TEN outside of the skin, eyes, and oral mucosa are not well defined or well recognized, and, therefore, are often not addressed clinically. As supportive care improves and mortality from SJS/TEN decreases, chronic complications in affected organ systems are becoming more prevalent. Recognition of the manifestations of SJS/TEN in the acute phase is critical to optimal care. In this review, we review the organ systems that may be involved in SJS/TEN, provide an overview of their management, and propose a list of items that should be communicated to the patient and family upon discharge. The organ systems discussed include the pulmonary, gastrointestinal/hepatic, oral, otorhinolaryngologic, gynecologic, genitourinary, and renal systems. In addition, the significant psychosocial, nutritional, and pain consequences and management of SJS/TEN are discussed.

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Section: Physical and Occupational Therapymentioning

confidence: 99%

Multidisciplinary care in Stevens-Johnson syndrome

Shanbhag

Chodosh

Fathy

et al. 2020

Therapeutic Advances in Chronic Disease

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“…Excellent nursing care with routine bathing or hydrotherapy, meticulous wound cleansing, dressings of thirds solution (one-third each of saline, peroxide and acetic acid) [McDonald et al 1989] and regular painting with local antiseptics have also been advised. Silver sulfadiazine is not recommended, as it has been implicated in toxic epidermal necrolysis and could cause neutropenia (Halebian et al 1983) and delay epithelialisation (Burleson & Eiseman 1973).…”

Section: Bum Intensive Care Unitsmentioning

confidence: 99%

“…Yet others have reported some forms of oral, idiopathic and recurrent erythema multiforme responding to corticosteroids and to the immunomodulating agent levamisole (Lozada 1982;LozadaNur et al 1989). McDonald et al (1989) recently delineated guidelines for rehabilitative management of patients with severe skin reactions to drugs, emphasising the necessity for early intervention despite its associated discomfort.…”

Section: Erythema Multiformementioning

confidence: 99%

Clinical Features and Management of Severe Dermatological Reactions to Drugs

1990

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Cutaneous adverse drug reactions are a frequent occurrence and have been reported in more than 2% of hospitalised patients. Among the most commonly involved drugs are sulphonamides, penicillins, anticonvulsants and non-steroidal anti-inflammatory drugs. Two groups of mechanisms are involved in the pathogenesis of drug reactions: immunological, with all 4 types of hypersensitivity reactions described; and non-immunological, accounting for at least 75% of all drug reactions. Besides minor skin reactions like urticaria, maculopapular rash, fixed eruptions or erythema nodosum, which are generally self-limited, severe life-threatening manifestations also occur. Erythema multiforme is secondary to drugs in half the cases; the minor form is characterised by typical target and iris lesions and is usually benign. However, a much more severe condition, erythema multiforme major or Stevens-Johnson syndrome, is associated with mucosal, ocular and visceral involvement, and carries a mortality of 5 to 15% if untreated. Toxic epidermal necrolysis, which could represent an even more dramatic form of the same disease, is characterised by severe widespread erythema, blisters and loss of skin in sheets, with denudation of more than 10% of the body surface area. This entity is frequently due to drugs. Mortality is 25 to 70%, and 90% of the survivors will have sequelae. Exfoliative dermatitis is an erythematous scaling disease often produced by drugs and carrying significant mortality. Photodermatitis may at times present with severe eczematous features. For clinical and epidemiological reasons it is important to try to identify the culprit drug following an approach based on previous experience with the drug, timing of events, patient reaction to dechallenge, patient reaction to rechallenge (if feasible), alternative aetiological candidates, and drug concentration or evidence of overdose. Management of severe skin reactions to drugs should require admission to a burn unit, where patients should be placed in warmed air-fluidised beds, receive excellent nursing care, analgesics and tranquillisers. Peeling necrotic epidermis should be removed and denuded dermis covered with biological grafts or synthetic dressings. Fluid balance must be adequately maintained; nutritional support and careful monitoring of early signs of skin infections is mandatory to ensure immediate antimicrobial treatment. Ocular care must be excellent to avoid serious sight-threatening sequelae. Steroids are presently not recommended. With these therapeutic modalities, morbidity and mortality can be markedly decreased.

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