Toxic epidermal necrolysis: 15 years' experience in a Dutch burns centre.
BACKGROUND
Toxic epidermal necrolysis (TEN) is a severe and potentially fatal drug reaction characterized by an extensive skin rash with blisters and exfoliation, frequently accompanied by mucositis. The wounds caused by TEN are similar to second-degree burns and severe cases may involve large areas of skin loss.


OBJECTIVE
Analysis of our results in patients with TEN and evaluation of the variety of therapeutic interventions that has been studied and suggested in TEN.


METHODS
Retrospective analysis of 19 consecutive patients with TEN treated in our burns centre between 1989 and 2004.


RESULTS
Immediate withdrawal of any potentially fatal drug, maximum supportive care, and a restricted and tailored antibiotic, medical and surgical treatment regimen confined mortality to 21%, whereas prognosis scores like APACHE II and SCORTEN predicted mortality of 22 and 30%, respectively. A positive contribution of selective digestive decontamination is suggested but has yet to be established.


CONCLUSIONS
Because of a potentially fatal outcome, fast referral of a patient suspected of TEN to a specialized centre (mostly a burns unit or specialized dermatology centre) for expert wound management and tailored comprehensive care is strongly advised and contributes to survival.
Gerdts
B
B
Rode Kruis Ziekenhuis, Burns Centre, Department of Surgery, Beverwijk, The Netherlands. B.Gerdts@chello.nl
Vloemans
A F P M
AF
Kreis
R W
RW
D000293:Adolescent; D000328:Adult; D000368:Aged; D002053:Burn Units; D002648:Child; D006801:Humans; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome