title: Management of dysphagia in toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS).
abstract: Toxic epidermal necrolysis (TEN) is a rare and potentially fatal skin disorder, precipitated by severe allergic drug reaction, and is one of a spectrum of conditions, which includes Stevens-Johnson syndrome (SJS). Mucosal involvement is common, resulting in extreme pain on swallowing and poor oral intake. The aim of this study was to describe swallow function in TEN and SJS and define the role of Speech Pathology in management. The Burns Unit database was reviewed for patients that presented over a five-year period with TEN and SJS. Diagnosis of TEN and SJS was confirmed by skin biopsy. Information specific to swallow function, treatment approaches, and adequacy of oral intake was collected. Fourteen patients' medical records were studied: eight TEN, two TEN/SJS spectrum, and four SJS. The majority had mucosal involvement causing odynophagia, poor oral intake, an ability to tolerate fluids more easily than solids, and increased aspiration risk. These symptoms were confirmed by Speech Pathology swallowing assessment. Severe mucosal involvement resulting in odynophagia, dysphagia, and poor oral intake is common in TEN and SJS. The speech pathologist is able to assess swallow function and provide recommendations to promote safe oral intake, minimize odynophagia, and facilitate nutritional input critical to optimizing recovery.
authors.affiliation: Burns Unit, Concord Repatriation General Hospital, Hospital Road, Concord, New South Wales, 2139, Australia. ncla3136@mail.usyd.edu.au
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Clayton
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kennedy
mesh_terms: D002056:Burns / Q000453:epidemiology; D003680:Deglutition Disorders / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D009752:Nutritional Status; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000453:epidemiology*