title: Granulocyte colony-stimulating factor in toxic epidermal necrolysis (TEN) and Chelsea & Westminster TEN management protocol [corrected].
abstract: BACKGROUND
  Toxic epidermal necrolysis (TEN) is a rare but life-threatening, allergic drug reaction. Skin blistering with epidermal and mucosal necrolysis with subsequent detachment from an inflamed underlying dermis is a hallmark of the condition. The pathogenesis of TEN is not well understood, accounting for controversies about its management and significant delay in initiating potentially beneficial therapy. There are no management protocols based on a robust evidence base.
  
  
  OBJECTIVE
  Prompt recognition of the diagnosis and consensus on early management initiatives are necessary in order to improve outcomes and survival in TEN. To date, TEN management has been directed at arresting the allergic reaction and treating the complications. We have identified a need for specific medical interventions to accelerate wound regeneration. This approach has not previously been adopted in the management of TEN.
  
  
  METHODS
  We observed that in two cases of severe TEN, dramatic re-epithelialization and recovery coincided with the introduction of granulocyte colony-stimulating factor (G-CSF) for neutropenia. We explain how addition of the G-CSF promotes recovery from TEN by enhanced bioregeneration of the damaged tissues through accelerated re-epithelialization.
  
  
  CONCLUSIONS
  G-CSF has been used for severe neutropenia in TEN, but we recommend and explain why, as in our Chelsea and Westminster protocol, G-CSF should be considered in treating severe TEN irrespective of the severity of neutropenia.
authors.affiliation: Department of Dermatology, Queen Elizabeth Hospital, Woolwich, London SE18 4QH, U.K. anna.dermatology@googlemail.com
authors.forename: A
authors.initials: A
authors.lastname: de Sica-Chapman
authors.forename: G
authors.initials: G
authors.lastname: Williams
authors.forename: N
authors.initials: N
authors.lastname: Soni
authors.forename: C B
authors.initials: CB
authors.lastname: Bunker
mesh_terms: D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*
chemical_list: D016179:Granulocyte Colony-Stimulating Factor