Treatment of Extensive Toxic Epidermal Necrolysis in Children

Abstract

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.

Intravenous Immunoglobulin in the Treatment of Vancomycin-Induced Toxic Epidermal Necrolysis = الغلوبيولين المناعي الوريدي في علاج إنحلال البشرة السمي الناتج عن الفانكوميسين

“…TEN occurred after starting antibiotics in 73% of patients in Marcus's study. 9 An adverse drug reaction is defined as a response to a drug which is noxious and unintended that occurs at doses normally used for prophylaxis, diagnosis or therapy of disease, or for the modification of physiologic function. 7 Type A reactions are dose-dependent and predictable while type B reactions (idiosyncratic) are dose -independent.…”

Severe Cutaneous Adverse Reactions

“…The contrasting measures of surgical debridement with whirlpool therapy to remove necrotic epidermis, and anti-shear wound care [125], in which detached skin is left in situ to act as a biological dressing [126], both have equivalent rates of reepithelialization and survival. Non-adherent nanocrystalline-containing gauzes are being increasingly used because of their broad antimicrobial effects [127], [128].…”

Lyell – szindróma gyermekkorban

“…Felnôttekben az adekvát intenzív ellátás mellett is a kórkép letalitása 30-50%, gyermekekben ennél lényegesen jobb prognózis jellemzô. A bôrgyógyászati szövôdmények közül leggyakrabban pigmentációs rendellenesség, dyschromia, hypo-és hyperpigmentált területek megjelenése észlelhetô, ez az eltérés gyakran évekig fennáll (13)(14)(15). A betegek egy részénél eruptívan nagyszámú festéksejtes naevus megjelenését észlelik.…”

“…Az akut szemészeti ellátás során a lokális antibiotikumos készítmények megelôzik az infekciók kialakulását és a szteroid tartalmú szemcseppek csökkentik az akut gyulladást, ezek mellett szükség van megfelelô lubrikáns készítmények rendszeres használatára is (6,(12)(13)(14)16,17). A lubrikánsok jelentôs segítséget nyújthatnak a késôi szö-vôdmények megelôzésében és kezelésében is (11,12,15,16,18,19). Adhéziók észlelése esetén naponta szükséges a fornix területének tisztítása, debridement, illetve üveg-pálcácal adhézió-lízis végzése.…”