Wound Management in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Jaller, Jose A.; McLellan, Beth N.; Balagula, Yevgeniy

doi:10.1007/s13671-020-00285-3

Cited by 9 publications

(15 citation statements)

References 91 publications

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“…Anti-shear therapy is an alternative to surgical debridement and could reduce hospital costs as well as pain. However, there is a lack of high-quality evidence to guide decision-making regarding surgical debridement [ 77 ], and further studies are needed to fully understand the role of this therapy.…”

Section: Clinical Updatesmentioning

confidence: 99%

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management

et al. 2021

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Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare diseases that are characterized by widespread epidermal necrosis and sloughing of skin. They are associated with significant morbidity and mortality, and early diagnosis and treatment is critical in achieving favorable outcomes for patients. In this scoping review, Excerpta Medica dataBASE and PubMed were searched for publications that addressed recent advances in the diagnosis and management of the disease. Multiple proteins (galectin 7 and RIP3) were identified that are promising potential biomarkers for SJS/TEN, although both are still in early phases of research. Regarding treatment, cyclosporine is the most effective therapy for the treatment of SJS, and a combination of intravenous immunoglobulin (IVIg) and corticosteroids is most effective for SJS/TEN overlap and TEN. Due to the rare nature of the disease, there is a lack of prospective, randomized controlled trials and conducting these in the future would provide valuable insights into the management of this disease.

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Section: Clinical Updatesmentioning

confidence: 99%

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management

et al. 2021

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“…Despite expert consensus advocating for dressings for wound care in patients with TEN, 23 there is limited high-quality evidence to guide treatment, and there is great variability in approaches across institutions. 20,29,57 This systematic review and meta-analysis of IPD aimed to evaluate the optimal approach to wound care in patients with TEN.…”

Section: Discussionmentioning

confidence: 99%

“…22,29 The alternative involves leaving the epidermis in situ to serve as a biological dressing, in combination with supportive dressings. 16,20,30 This has been reported to improve wound healing and has comparable mortality rates to surgical debridement. 16 Guidelines from France support a dressingbased approach with minimal manipulation of the skin and non-adhesive dressings, 16 which has been postulated to facilitate early wound healing.…”

Section: Introduction Backgroundmentioning

confidence: 99%

“…[16][17][18][19] The principles of wound care include protection of the underlying exposed dermis, minimisation of infection, reducing the risk of pigment changes and scarring, optimising re-epithelialisation and prevention of insensible fluid losses. 20 However, there remain differences in opinion with respect to specific wound care for patients with TEN. 20,21 Specifically, wound care can be a surgical approach, that being debridement, or supportive dressings, 17 where the detached epidermis is left in situ to act as a biological dressing for the underlying dermis.…”

Section: Introduction Backgroundmentioning

confidence: 99%

“…20 However, there remain differences in opinion with respect to specific wound care for patients with TEN. 20,21 Specifically, wound care can be a surgical approach, that being debridement, or supportive dressings, 17 where the detached epidermis is left in situ to act as a biological dressing for the underlying dermis. 22 Despite recent guidelines for the management of SJS/ TEN developed from a Delphi consensus of dermatology hospitalists recommending against debridement of necrotic skin, 23 there is limited evidence and no gold or universally accepted standard for wound care in patients with SJS/TEN.…”

Section: Introduction Backgroundmentioning

confidence: 99%

See 2 more Smart Citations

An individual patient data meta‐analysis of wound care in patients with toxic epidermal necrolysis

Lee,

Mallitt,

Fischer

et al. 2023

Aust J Dermatology

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Toxic epidermal necrolysis (TEN) involves extensive mucocutaneous loss, and care is supportive. The approach to wound care includes surgical debridement or using dressings while leaving the epidermis intact. Robust evidence for either approach is lacking. We compared surgical debridement to the use of dressings while leaving the epidermis in situ (referred to hereon as dressings) in adult patients with TEN. The primary outcome assessed was mortality. The secondary outcome was time to re‐epithelialisation. The impact of medications was evaluated. An individual patient data (IPD) systematic review and meta‐analysis was undertaken. A random effects meta‐analysis and survival analysis for IPD data examined mortality, re‐epithelisation time and the effect of systemic medications. The quality of evidence was rated per the Grading of Recommendations Assessment, Development and Evaluation (GRADE). PROSPERO: CRD42021266611 Fifty‐four studies involving 227 patients were included in the systematic review and meta‐analysis, with a GRADE from very low to moderate. There was no difference in survival in patients who had surgical debridement or dressings (univariate: p = 0.91, multivariate: p = 0.31). Patients who received dressings re‐epithelialised faster than patients who underwent debridement (multivariate HR: 1.96 [1.09–3.51], p = 0.023). Intravenous immunoglobulin (univariate HR: 0.21 [0.09–0.45], p < 0.001; multivariate HR: 0.22 [0.09–0.53], p < 0.001) and cyclosporin significantly reduced mortality (univariate HR: 0.09 [0.01–0.96], p = 0.046; multivariate HR: 0.06 [0.01–0.73], p = 0.028) irrespective of the wound care. This study supports the expert consensus of the dermatology hospitalists, that wound care in patients with TEN should be supportive with the epidermis left intact and supported with dressings, which leads to faster re‐epithelialisation.

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Management of Drug-Induced Epidermal Necrolysis (DEN) in Pediatric Patients: Moving from Drug-Induced Stevens–Johnson Syndrome, Overlap and Toxic Epidermal Necrolysis to a Single Unifying Diagnosis of DEN

2022

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Wound Management in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Cited by 9 publications

References 91 publications

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management

An individual patient data meta‐analysis of wound care in patients with toxic epidermal necrolysis

Management of Drug-Induced Epidermal Necrolysis (DEN) in Pediatric Patients: Moving from Drug-Induced Stevens–Johnson Syndrome, Overlap and Toxic Epidermal Necrolysis to a Single Unifying Diagnosis of DEN

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