Silicone gel treatment of extensive hypertrophic scarring following toxic epidermal necrolysis

Kavanagh, G.M.; Pagé, Pierre; Hanna, Marshall

doi:10.1111/j.1365-2133.1994.tb03396.x

Cited by 23 publications

(16 citation statements)

References 5 publications

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“…No child required skin grafting. Although it has been reported, 39 only 1 child in our series developed hypertrophic changes in a localized area of the upper back.…”

Section: Discussioncontrasting

confidence: 57%

Long-Term Consequences of Toxic Epidermal Necrolysis in Children

et al. 2002

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ABSTRACT. Objective. Toxic epidermal necrolysis (TEN) is an acute inflammatory systemic condition that involves injury not just to the skin. Historically, it has been associated with a high mortality but few long-term consequences among survivors. With improved survival, long-term consequences may be becoming more apparent. The objective of this study was to define these longterm consequences and their frequency.Methods. From July 1, 1991, to June 30, 2000, 11 children with severe TEN were referred to a regional pediatric burn facility. Wounds were managed with a strategy involving prevention of wound desiccation and superinfection, including the frequent use of biological wound coverings. All children survived and have been followed in the burn clinic. The records of all children were reviewed in detail.Results. Two boys and 9 girls with an average age of 7.2 ؎ 1.8 years (range: 6 months-15 years) and sloughed surface area of 76 ؎ 6% of the body surface (range: 50%-95%) were admitted to the burn unit for care. Antibiotics (3 children), anticonvulsants (4 children), nonsteroidals (2 children), and viral syndrome or unknown agents (2 children) were believed to have triggered the syndrome. Six (55%) children required intubation for an average of 9.7 ؎ 1.8 days (range: 2-14 days). Mucosal involvement occurred in 10 (91%) and ocular involvement in 10 (91%). Lengths of stay averaged 19 ؎ 3 days (range: 6 -40 days). Overall follow-up averaged 14 ؎ 13 months. Three children had no apparent long-term consequences of the disease and were referred to primary care follow-up after the 2-month burn clinic visit. The remaining children had follow-up averaging 23 ؎ 13 months. The most common long-term morbidity involved eyes (3 children T oxic epidermal necrolysis (TEN) is an acute inflammatory systemic condition that involves injury to the skin, mucous membrane, and sometimes bowel and respiratory epithelium. The syndrome was first clearly described by Lyell in 1956 1,2 and is now believed to represent the most severe form of a disease spectrum beginning with Stevens-Johnson syndrome (SJS). [3][4][5] In SJS, mucous membranes are characteristically denuded. Some children with SJS have macular skin lesions as well, usually involving Ͻ30% of the body surface. In TEN, both skin and mucous membranes are denuded, involvement of Ͼ30% of the body surface is characteristic, 6 and mucosal surface involvement may extend into the respiratory and gastrointestinal tracts. Patients with TEN can therefore be considered as having both a cutaneous and a visceral wound. The morbidity and mortality of the condition is as related to involvement of visceral surfaces as it is to that of the cutaneous wound.[Although there are no large exclusively pediatric data sets, patients with TEN are generally reported to have a mortality as high as 70% 7 ; death usually results from sepsis or organ failure. During the past several years, these children have been increasingly referred to burn units, as their needs are similar to those of children with extensiv...

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“…No child required skin grafting. Although it has been reported, 39 only 1 child in our series developed hypertrophic changes in a localized area of the upper back.…”

Section: Discussioncontrasting

confidence: 57%

Long-Term Consequences of Toxic Epidermal Necrolysis in Children

et al. 2002

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“…15,27,28 Hypertrophic scars, although rare, have been reported. 13,15 Nine of the 13 subjects in our series (69%) had persistent changes in skin pigmentation. Although none of our patients developed hypertrophic scarring, interestingly, punctate keloids occurred in two cases at sites onto which surgical staples had been inserted to secure skin substitutes.…”

Section: Discussionmentioning

confidence: 79%

Late Outcomes in Adult Survivors of Toxic Epidermal Necrolysis After Treatment in a Burn Center

Haber¹,

Hopman²,

Gómez³

et al. 2005

Journal of Burn Care & Rehabilitation

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Despite improved survival after burn center treatment for patients with toxic epidermal necrolysis (TEN), little is known about the overall long-term outcomes in these patients. In this work we sought to analyze late outcomes in survivors of TEN who were treated in our burn center. Subjects completed a questionnaire that included the RAND 36-Item Health Survey (SF-36) and the Dermatology Life Quality Index. Subjects were examined, when possible, and completed the Functional Independence Measure. Scores on the SF-36 were compared with age- and sex-matched National normative data. All results are presented as the mean +/- SD. Of 35 adults admitted with TEN between January 1, 1995, and January 6, 2003, 10 have died in hospital, 4 have died since discharge, and 8 have been lost to follow-up, leaving a study population of 13 subjects (age 45 +/- 18 years with initial %TBSA involvement 65 +/- 29). Follow-up occurred at 38 +/- 27 months after discharge. The most common ophthalmic problems were chronic photosensitivity (54%) and dry eyes (31%). The Dermatology Life Quality Index (maximum-worst score = 30) was 9 +/- 10. SF-36 scores were significantly lower than in the age- and sex-matched normal population across all domains except mental health. The Functional Independence Measure score (maximum-best score = 126) was 123 +/- 4. Survivors of TEN demonstrate a high level of independent function in activities of daily living, but numerous complications of TEN significantly impair their overall quality of life, emphasizing the need for long-term follow-up.

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“…22 Also, the distinction between keloids and hypertrophic scars is not clear. [23][24][25] In several previous studies, other methods have been used, such as triamcinolone injection, excision, compression, and silicone treatment, 4,6,18,26,27 and it became difficult to isolate the effect of the dressing alone. 10 In the present study, patients who had received other treatment methods were not accepted into the protocol.…”

Section: Discussionmentioning

confidence: 99%