Collagen sheet dressings for cutaneous lesions of toxic epidermal necrolysis

Bhattacharya, Surajit; Tripathi, H. D.; Gupta, Ved Prakash; Nigam, Bharti; Khanna, Ajay K.

doi:10.4103/0970-0358.90826

Cited by 11 publications

(10 citation statements)

References 6 publications

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“…For severe cases involving loss of epidermis, wound management goals are to prevent fluid loss, prevent infection and facilitate re-epithelialization [10]. Different occlusive non-adhesive wound coverings that prevent fluid loss and minimize pain with dressing changes have been recommended for wound management [34]. These biological dressings create a physiological interface between the wound surface and the environment that is impermeable to bacteria, thus helping to prevent local wound infection [35].…”

Section: Discussionmentioning

confidence: 99%

Toxic Epidermal Necrolysis After Exposure to Dithiocarbamate Fungicide Mancozeb

Zakharov

Csomor

Urbánek

et al. 2015

Basic Clin Pharma Tox

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Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous disease with high mortality. Dithiocarbamates (DTC) are organosulphur compounds widely used in agriculture, industry and households. We report a case of TEN after exposure to mancozeb in fungicide. A 48-year-old 75 kg b.w. man was admitted with fever and generalized skin/mucous lesions after application of fungicide in a home garden. The patient had necrotic desquamation of gastrointestinal/respiratory tract mucosa, ocular lesion and skin epidermolysis of 90% of body surface. The laboratory findings included elevation of inflammatory parameters, hyperglycaemia, increased urea, creatinine, liver enzymes, hypoalbuminemia and electrolyte disturbances. The treatment included supportive care, management of fluid/electrolyte requirements, analgesics and enteral nutrition. Skin lesions were treated with occlusive non-adhesive biological wound dressings. Due to the proof of Acinetobacter, Escherichia coli and Escherichia faecalis from skin swabs, a combination of meropenem with amikacin was administered. During the next 2 weeks, complete re-epithelialization of skin lesions occurred, mucosal lesions healed and the laboratory parameters returned to normal. The patient was discharged on day 42. TEN is a rare condition that is generally caused by medications. Nevertheless, high attention should be paid to the cases of occupational or household exposure to DTC fungicides widely used in agriculture and home gardens because of their ability to cause TEN after skin and inhalation exposure. Greater emphasis on the hazardous properties of these products is necessary to ensure non-professional users are aware of the necessity of protective clothing during mixing, loading, application and early re-entry into treated fields.Toxic epidermal necrolysis (TEN), or Lyell's syndrome, is an acute life-threatening mucocutaneous disease with an epidermal loss of more than 30% of the body surface area and the involvement of at least two mucosal surfaces comprising ocular, oral and genital [1,2]. It is a rare condition with an incidence of 0.4-1.2 cases per million persons per year, but with a high mortality rate of 30-50% [3][4][5]. The morbidity and mortality result not only from the extensive denuded skin areas but also from the visceral involvement -particularly in the gastrointestinal and respiratory systems -sepsis, and multiple organ failure [6].The mechanism of TEN is not fully understood, but it appears to be the activation of autoimmune hypersensitivity reaction by the causative agents or their metabolites, as rechallenging an individual with the same agent can result in rapid recurrence of TEN [7,8]. The histopathology of skin lesions shows that keratinocyte apoptosis followed by necrosis is the pathogenic basis of the widespread epidermal detachment observed in TEN [9].Medications are the most frequent triggers of TEN, and more than 100 drugs have been implicated, including antibacterial sulphonamides, aromatic anticonvulsants, allopurinol, oxicam nonst...

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Section: Discussionmentioning

confidence: 99%

Toxic Epidermal Necrolysis After Exposure to Dithiocarbamate Fungicide Mancozeb

Zakharov

Csomor

Urbánek

et al. 2015

Basic Clin Pharma Tox

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“…12 The initial lesions are sometimes referred to as targetoid lesions because of the target appearance, with 2 zones of color. 13 The rash usually involves the head, anterior and posterior torso, upper extremities, and lower extremities to above the knees and may progress to include lower back and gluteal area (see Figures 1 and 2). 8 The most important signs of an impending severe cutaneous reaction are skin pain, epidermolysis, and a positive Nikolsky's sign (slight rubbing of the skin causes separation of the epidermis and dermis).…”

Section: Clinical Presentationmentioning

confidence: 99%

“…24 Debridement of detached epidermal tissue is controversial and usually not advisable in patients who have a positive Nikolsky sign. 2 Collagen sheet dressings, 13 Biobrane (Dow B. Hickam, Inc, Sugarland, TX, USA), 8 and other occlusive nonadhesive wound coverings that prevent fluid loss and minimize pain with dressing changes have been recommended. These biological dressings create a physiological interface between the wound surface and the environment that is impermeable to bacteria, thus helping to prevent local wound infection.…”

Section: Wound Managementmentioning

confidence: 99%

“…25 In addition, the collagen sheets are noninflammatory, facilitate fibroblast migration to the wound site, assist in extracellular matrix synthesis, are nontoxic, and minimize scarring. 13 Conformant (Smith & Nephew, Inc, Largo, FL, USA) is a nonadherent contact layer that comes in rolls and can be applied to large involved areas outside the operating room. Secondary absorbent layers are applied over the contact layer and changed as needed, thereby reducing the number of direct dressing changes.…”

Section: Wound Managementmentioning

confidence: 99%

See 1 more Smart Citation

Drug-Hypersensitivity Syndrome: Diagnosis and Treatment

Hamm¹

2011

Journal of the American College of Clinical Wound Specialists

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“…In the early 1970's, John F. Burke and Ioannas Yannas developed a bio-compatible collagen matrix to improve wound healing. It is commonly used in the management of burns, [6] diabetic foot ulcer, [7,8] toxic epidermal necrolysis, [9] chronic wounds, etc. [10][11][12] This versatile material also finds its application in the field of plastic surgery, oral and maxillofacial surgery and dentistry for various purposes e.g.…”

Section: Collagen As a Biomaterials In Plastic And Reconstructive Surgerymentioning

confidence: 99%

Collagen membrane for reconstruction of soft tissue defects after surgery of oral cancer and precancer: a brief review

Vastani¹,

Chourasia²,

Pahlajani³

et al. 2016

PAR

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There are some surgeries after which a temporary cover for raw wounds is required to ensure healing. Some of those circumstances are loss of tissue due to burns, trauma, amputation, chronic ulcer, leprosy, and skin graft sites. Although the body initiates regeneration mechanisms, however the time taken for complete healing of wounds is unpredictable. Also, there is a tendency for long standing wounds to undergo infection and scarring. Oral mucosa is no exception to scarring and infection of wounds and there has always been a search for new materials that can be used for coverage of oral defects. Xenogenous collagen is one such grafting material. Over the years collagen implant solutions for a number of clinical applications include general surgery, burn surgery, neurosurgery, plastic and reconstructive surgery, oral surgery, and peripheral nerve and tendon surgery. This paper aims to focus on collagen as an effective option of wound closure in plastic and reconstructive surgery of the head and neck, especially after loss of soft tissue following resection of oral malignancies.

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Collagen sheet dressings for cutaneous lesions of toxic epidermal necrolysis

Cited by 11 publications

References 6 publications

Toxic Epidermal Necrolysis After Exposure to Dithiocarbamate Fungicide Mancozeb

Toxic Epidermal Necrolysis After Exposure to Dithiocarbamate Fungicide Mancozeb

Drug-Hypersensitivity Syndrome: Diagnosis and Treatment

Collagen membrane for reconstruction of soft tissue defects after surgery of oral cancer and precancer: a brief review

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