Treatment of Toxic Epidermal Necrolysis With Moisture-Retentive Ointment: A Case Report and Review of the Literature

Abstract

Toxic epidermal necrolysis (TEN) is a rare condition that was described by Lyell in 1956. It is a severe, acute, adverse, primarily drug‐induced, potentially fatal, cutaneous reaction that is characterized by large areas of skin desquamation and sloughing, similar in many aspects to second‐degree burns. The treatment of cutaneous drug reactions rests essentially on immediate diagnosis and recognition of the disease process, accurate history, thorough physical examination, prompt discontinuation of the offending drug, and supportive care. TEN patients are best managed in specialized burn units. Nevertheless, the management remains very much individualized, based on the clinical setting. Topical wound care remains an essential factor in the treatment of burn‐like syndromes and is a main determining parameter for morbidity and mortality. As the value of moist environment in wound healing is being fully appreciated, we report on the use of a newly introduced ointment, the Moist Exposed Burn Ointment (Julphar; Gulf Pharmaceutical industries, Ras El‐Khaymah, United Arab of Emirutes), a moisture‐retentive ointment, in the successful management of a case of TEN.

Severe Cutaneous Adverse Reactions

“…Infection and sepsis with multiorgan failure is the most common of death. The causative organisms are usually Staphylococcus aureus and Pseudomonas aeruginosa [29]. Fluid and electrolyte imbalances occur as a result of increased transepidermal water loss and impaired intake of nutrition due to odynophagia from stomatitis.…”

Severe Cutaneous Adverse Reactions

“…Infection and sepsis with multiorgan failure is the most common of death. The causative organisms are usually Staphylococcus aureus and Pseudomonas aeruginosa (Atiyeh, Dham et al 2003). Fluid and electrolyte imbalances occur as a result of increased transepidermal water loss and impaired intake of nutrition due to odynophagia from stomatitis.…”

Secondary Bacterial Infection and Empirical Antibiotic Use in Toxic Epidermal Necrolysis Patients

“…Septicemia has been described as the most frequent cause of death in TEN patients. 2,3 Sepsis has been validated previously as an important prognostic factor that increases mortality in TEN patients. 4,5 The impaired barrier function caused by the devitalization of epidermis in TEN appears to predispose to wound infection, most commonly with Staphylococcus aureus or P. aeruginosa.…”

“…4,5 The impaired barrier function caused by the devitalization of epidermis in TEN appears to predispose to wound infection, most commonly with Staphylococcus aureus or P. aeruginosa. 1,2 Devitalization of tissues can extend to mucous membranes of the gastrointestinal, respiratory, and genitourinary tracts, thus increasing the spectrum of microorganisms that can cause infection.…”