Erythema multiforme. Should anyone care about the standards of care?

Rasmussen, James E.

doi:10.1001/archderm.131.6.726

Cited by 18 publications

(11 citation statements)

References 19 publications

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“…Under this scheme, SJS is considered to affect Ͻ10% of total body surface area (TBSA), whereas TEN covers Ͼ30% of TBSA, leaving a zone of overlap between 10% and 30% of TBSA, which is referred to as SJS/TEN. 1,[3][4][5][6][7] TEN and SJS both seem to be caused by immunologic reactions to foreign antigens. Drugs are implicated in 77% to 94% of cases.…”

mentioning

confidence: 99%

“…15 For pediatric patients and more extensive cases involving Ͼ10% of TBSA, the current literature recommends transfer to a burn center early in the disease process. 4,19,20 The general recommendation for treatment of severe cases of TEN is the removal of necrotic epidermis and topical treatment of the wounds. 1,21,22 Similar to scald burns, the affected areas heal within 2 to 3 weeks if wound infections can be avoided.…”

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confidence: 99%

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Treatment of Extensive Toxic Epidermal Necrolysis in Children

et al. 2001

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ABSTRACT. Objective. Toxic epidermal necrolysis (TEN) is a rare but life-threatening disease of the skin and mucous membranes. We report our experience in the treatment of pediatric TEN patients with early debridement of necrotic skin and coverage with human allograft skin.Methods. From 1984 to 2000, 15 children (6 girls, 9 boys, 7.2 ؎ 1.5 years) with a histologic diagnosis of TEN and involvement of >30% total body surface area were treated at the Shriners Hospitals for Children in Galveston. All were treated in a specialized pediatric burn intensive care unit after our standard treatment protocol, including operative debridement of sloughing skin and allografting within 24 hours of admission. Outcome parameters were mortality, length of hospital stay, wound healing, clinical complications, causative drugs, corticosteroid use, and delay in referral to a burn center. Results. Taking a new medication (antibiotics, anticonvulsive drugs) was associated with all cases of TEN.Patients who were treated with early debridement and coverage with allograft skin showed no wound infection, and overall mortality was 7%. Total length of hospital stay was 26 ؎ 3 days. Long-term sequelae were changes in skin pigmentation (100%), ophthalmologic problems (40%), and diffuse itching early after wound healing (53%).Conclusion. Although a rare disease in children, TEN was managed successfully in a burn center environment, using early debridement and wound coverage with allograft skin as a biological dressing. The use of corticosteroids and referral patterns seems unchanged during the past 2 decades, indicating an additional need for information and education about the disease. Pediatrics 2001; 108:1162-1168; toxic epidermal necrolysis, children, burn center, mortality, biological dressing.

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Treatment of Extensive Toxic Epidermal Necrolysis in Children

et al. 2001

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“…Bei fokalem Hautbefall spricht man von Erythema multiforme minor, bei einem Haut-und Schleimhautbefall von bis zu 10% der gesamten Körperober-fläche spricht man von SJS, bei einer Ausdehnung von mehr als 30% von toxisch epidermaler Nekrolyse (TEN). Die Grauzone von 10-30% Ausdehnung wird oft als "overlap" SJS/TEN bezeichnet [3,19].…”

Section: Definition Und Epidemiologieunclassified

“…Pathognomonisch ist das Nikolski-Phänomen: auf leichten Fingerdruck und geringe Scherkräfte hin kommt es zur Blasenbildung und Ablösung der Epidermis. Die Latenzperiode von Medikamentenexposition bis zur kutanen Eruption liegt bei 1-3 Wochen, nach vorausgegangener Sensibilisierung und Reexposition kann sie jedoch deutlich kürzer verlaufen [2,3,19]. Sowohl beim Stevens-Johnson-Syndrom als auch bei der TEN sind typischerweise 2 oder mehrere Schleimhautregionen betroffen (Abb.…”

Section: Klinikunclassified

“…Im Hinblick auf die oben genannten pathogenetischen Theorien erscheint die Gabe von systemischen Kortikosteroiden im frühen Akutstadium sinnvoll [11]. Eine hoch dosierte systemische Kortikosteroidgabe unter der Vorstellung, das Fortschreiten der Erkrankung zu verhindern, wird jedoch weitestgehend abgelehnt, da Kortikosteroide das Risiko einer Sepsis und gastrointestinaler Blutungen erhöhen, den Proteinkatabolismus verstärken, die Wundheilung verzögern, den Krankenhausaufenthalt verlängern und die Sterblichkeit steigern [1,11,18,19,21]. Selbst unter chronischer Kortikoidmedikation vor Auftreten einer TEN ergab sich kein Überlebens-vorteil [9,24], und Kortikoide beinhalten selbst ein erhöhtes Risiko für die Auslösung einer TEN [22].…”

Section: Kortikosteroide -Standortbestimmungunclassified

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Toxisch epidermale Nekrolyse

Spies¹,

Vogt²,

Herndon

2003

Chirurg

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Toxic epidermal necrolysis is a rare but life-threatening exfoliating disease of the skin and mucous membranes, commonly considered a drug sensitivity reaction. In this review of the literature we discuss the epidemiology, etiology, and pathology. We show diagnostic problems and current treatment strategies. Many of the problems associated with the disease, such as wound infection, sepsis, nutritional support, and pain management, are similar to problems in severely burned patients. Burn centers provide optimal logistics and knowledge to diagnose and treat this serious disease entity.

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Allergic Reactions to Drugs and Biologic Agents

deShazo¹

1997

JAMA

181

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Drug allergies are adverse reactions resulting from immunologic responses to drugs or their metabolites. These reactions result in predictable patterns of organ-specific or systemic hypersensitivity that usually recur on subsequent exposure to the same drug. Although diagnostic testing for drug allergy is available for only a few drugs, protocols have been developed to assist in management of allergic reactions to many drugs and biologic agents. Other protocols assist in the management of patients who develop drug reactions while undergoing multiple drug therapy or those with a history of adverse drug reactions who again require treatment for the same condition.

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Erythema multiforme. Should anyone care about the standards of care?

Cited by 18 publications

References 19 publications

Treatment of Extensive Toxic Epidermal Necrolysis in Children

Treatment of Extensive Toxic Epidermal Necrolysis in Children

Toxisch epidermale Nekrolyse

Allergic Reactions to Drugs and Biologic Agents

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