Treatment of toxic epidermal necrolysis. Creteil's experience

Revuz, J.

doi:10.1001/archderm.123.9.1156

Cited by 37 publications

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“…In this study, the mortality was 37.5% for children with an involvement of 60% to 70% of TBSA (ADEN type 2) and 60% for those with an involvement of Ͼ70% of TBSA (ADEN type 3), which is significantly higher than our mortality of 7%. Two other studies with large patient numbers by Murphy et al 20 and Revuz et al 6 reported on 44 and 87 cases of TEN including patients aged from 0.8 to 90 years and 2 to 90 years, respectively. Unfortunately, in these studies, no information is given on the number of involved children.…”

Section: Discussionmentioning

confidence: 97%

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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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Section: Discussionmentioning

confidence: 97%

“…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.…”

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confidence: 99%

Treatment of Extensive Toxic Epidermal Necrolysis in Children

et al. 2001

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“…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 extensive burns: wound care and support of failing organ systems.…”

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confidence: 99%

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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“…The skin then sloughs rapidly over several days as a result of separation of large sheets of the epidermis from the dermis. Fulminant cases of TEN have been reported were total loss of the epidermis occurs within 24 hours [24] . New lesions may continue to erupt for up to 4 weeks.…”

Section: Clinical Presentationmentioning

confidence: 99%

Severe Cutaneous Adverse Reactions

Fernando¹

2013

Skin Biopsy - Diagnosis and Treatment

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Treatment of toxic epidermal necrolysis. Creteil's experience

Cited by 37 publications

References 0 publications

Treatment of Extensive Toxic Epidermal Necrolysis in Children

Treatment of Extensive Toxic Epidermal Necrolysis in Children

Long-Term Consequences of Toxic Epidermal Necrolysis in Children

Severe Cutaneous Adverse Reactions

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