Basic measures and systemic medical treatment of patients with toxic epidermal necrolysis.
BACKGROUND
With an incidence of 1.5-1.8/1 million inhabitants per year, toxic epidermal necrolysis is a rare but life threatening disease. It is almost always drug-induced and its lethality is pronounced with up to 50 %. Several therapeutic options are described in literature; however, there is still lack of a universally accepted and specific therapy of toxic epidermal necrolysis.


METHODS
This survey considers 8 cases of toxic epidermal necrolysis diagnosed and treated in our clinic from 2003 to 2007. The epidermal sloughing was > 30 % of the body surface in each case.


RESULTS
After immediately discontinuing the drug suspected of being responsible for toxic epidermal necrolysis, we treated with systemic corticosteroids in an initial dose of up to 1.5 mg/kg. Moreover, special emphasis was put on basic measures such as control of vital parameters. With this treatment we reached good results; none of the patients died. conclusions: Immediate beginning of therapy is essential for a successful treatment of toxic epidermal necrolysis. Besides systemic therapy with corticosteroids, certain basic measures such as isolation of patients at adequate room temperature to prevent hypothermia, strict control of circulation, temperature and laboratory parameters, daily smears of skin and mucous membranes and a diet rich in calories due to the catabolic metabolic status are very important for successful outcome.
Eduard Arning Clinic for Dermatology and Allergology, Asklepios Clinic St. Georg, Hamburg, Germany. i.hanken@asklepios.com
Imke
I
Hanken
Melanie
M
Schimmer
Christian A
CA
Sander
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000627:therapeutic use / Q000633:toxicity; D000900:Anti-Bacterial Agents / Q000627:therapeutic use / Q000633:toxicity; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use / Q000633:toxicity; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D002939:Ciprofloxacin / Q000627:therapeutic use / Q000633:toxicity; D004338:Drug Combinations; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use / Q000633:toxicity; D006074:Gout Suppressants / Q000627:therapeutic use / Q000633:toxicity; D006801:Humans; D006879:Hydroxocobalamin / Q000627:therapeutic use / Q000633:toxicity; D008012:Lidocaine / Q000627:therapeutic use / Q000633:toxicity; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000627:therapeutic use / Q000633:toxicity; D011241:Prednisone / Q000627:therapeutic use*; D011736:Pyridoxine / Q000627:therapeutic use / Q000633:toxicity; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015163:Superinfection / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D015996:Survival Rate; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use / Q000633:toxicity
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000927:Anticonvulsants; D004338:Drug Combinations; D006074:Gout Suppressants; D002939:Ciprofloxacin; D010672:Phenytoin; D000493:Allopurinol; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D005492:Folic Acid; D008012:Lidocaine; D011736:Pyridoxine; D006879:Hydroxocobalamin; D011241:Prednisone