Toxic epidermal necrolysis with severe hyperbilirubinemia: complete re-epithelialization after bilirubin reduction therapies.
Toxic epidermal necrolysis is a life-threatening skin disorder, and its mortality rate is estimated to be approximately 20-30%. It is characterized that more than 30% of the skin surface is eroded, however, skin lesions are usually re-epithelialized within 2-3 weeks. Previously, we reported a fatal case of toxic epidermal necrolysis with hyperbilirubinemia, and more than 60% of body surface areas had been eroded for 9 weeks. For the reason of delayed re-epithelialization, we hypothesized that hyperbilirubinemia was the culprit because bilirubin damaged cultured keratinocytes in vitro. In this case, we had an opportunity to treat another case of toxic epidermal necrolysis with severe hyperbilirubinemia. In order to reduce serum bilirubin levels, we performed bilirubin adsorption therapies, and skin lesions were successfully re-epithelialized within 4 weeks. Though further studies are required, we considered that bilirubin adsorption therapies are worth trying for toxic epidermal necrolysis with hyperbilirubinemia, especially for the cases suffering from delayed re-epithelialization.
Kamada
Noriaki
N
Department of Dermatology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan. ozmail@faculty.chiba-u.jp
Yoneyama
Kei
K
Togawa
Yaei
Y
Suehiro
Keisuke
K
Shinkai
Hiroshi
H
Yokota
Masaya
M
Matsuda
Kenichi
K
Oda
Shigeto
S
Hirasawa
Hiroyuki
H
Matsue
Hiroyuki
H
D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000150:complications* / Q000628:therapy; D010951:Plasma Exchange; D016060:Sorption Detoxification; D013262:Stevens-Johnson Syndrome / Q000150:complications* / Q000628:therapy; D014635:Valproic Acid / Q000009:adverse effects
D000927:Anticonvulsants; D014635:Valproic Acid