title: Toxic epidermal necrolysis/Stevens-Johnson syndrome: current trends in management.
abstract: BACKGROUND
  Toxic epidermal necrolysis (TEN) is an uncommon but potentially life-threatening condition that involves sloughing of the skin at the dermoepidermal junction. TEN is a well-recognized syndrome and is part of a range of severe mucocutaneous intolerance reactions, mostly elicited by drugs and/or their metabolites. Reported mortality rates vary widely from 20 to 75%. Several systemic treatment protocols for TEN have been published; however, none has been formally standardized in a randomized controlled trial. The present study documents the current management principles and trends seen in 16 patients admitted with TEN or Stevens-Johnson syndrome over a 5-year period at the Concord Repatriation General Hospital Burns Unit.
  
  
  METHODS
  Data were collected by retrospective chart review, and parameters included in the study were patient demographics, causative agents, percentage total body surface area and/or mucosal involvement, complications, treatment and outcome. In particular, dressing choice and documented healing of skin lesions were noted.
  
  
  RESULTS
  Sixteen patients were identified, with the beta-lactam antibiotics most commonly implicated as the cause. Complications tended to relate to degree of sepsis and/or mucous membrane involvement. Nanocrsytalline silver dressings, such as Acticoat (Smith & Nephew, Mount Waverley, Victoria, Australia), were used predominantly in more recent cases.
  
  
  CONCLUSIONS
  The shift in dressing choice from traditional Vaseline-impregnated gauze coincided with a general trend towards the use of nanocrystalline silver dressings for superficial burns after 2003. The nanocrystalline silver dressings have shown considerable advantage over previously used dressings, with no adverse reactions noted and good healing of the skin lesions for all patients.
authors.affiliation: Burns Unit, Concord Repatriation General Hospital, Sydney, New South Wales, Australia. rdalli@gmp.usyd.edu.au
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Dalli
authors.forename: Rohit
authors.initials: R
authors.lastname: Kumar
authors.forename: Peter
authors.initials: P
authors.lastname: Kennedy
authors.forename: Peter
authors.initials: P
authors.lastname: Maitz
authors.forename: Stephen
authors.initials: S
authors.lastname: Lee
authors.forename: Rae
authors.initials: R
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053758:Nanoparticles / Q000627:therapeutic use*; D011091:Polyesters / Q000627:therapeutic use*; D011095:Polyethylenes / Q000627:therapeutic use*; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy*
chemical_list: C117408:Acticoat; D011091:Polyesters; D011095:Polyethylenes