title: Toxic epidermal necrolysis (TEN): the Chelsea and Westminster Hospital wound management algorithm.
abstract: Toxic epidermal necrolysis syndrome (TEN) is a potentially catastrophic exfoliative muco-cutaneous disorder first described by Lyell in 1956. It represents the most extensive form of Steven-Johnson syndrome. TEN is defined varyingly around the globe, but in the United Kingdom the consensus opinion describes the process as involving >30% of the total body surface area. It can rapidly become more extensive and threatens life. The estimated annual incidence is approximately 1-2 cases per million population. The risk of mortality increases with surface area involved and meta-analysis of the literature shows this risk to be between 16% and 55%. Over a six month period the Chelsea and Westminster Hospital Burns Service treated five consecutive patients with more than 80% total body surface area involvement or a more than 80% mortality risk, using the severity-of-illness score for toxic epidermal necrolysis (SCORTEN). All patients were treated according to the Chelsea and Westminster Hospital wound management algorithm with excellent outcome and no mortalities. The aim of this paper is to propose a generic TEN wound management algorithm according to the severity of skin lesions, using a simple wound grading system.
authors.affiliation: Burns Service, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Abela
authors.affiliation: Burns Service, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK. Electronic address: ceahartmann@gmail.com.
authors.forename: Christoph E A
authors.initials: CE
authors.lastname: Hartmann
authors.affiliation: Burns Service, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: De Leo
authors.affiliation: Department of Dermatology, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: de Sica Chapman
authors.affiliation: Department of Dermatology, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK.
authors.forename: Hetul
authors.initials: H
authors.lastname: Shah
authors.affiliation: Burns Service, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Jawad
authors.affiliation: Department of Dermatology, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Bunker
authors.affiliation: Burns Service, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK.
authors.forename: Greg J P
authors.initials: GJ
authors.lastname: Williams
authors.affiliation: Burns Service, Chelsea and Westminster Hospital, 369 Fulham Road, London, UK.
authors.forename: Jorge
authors.initials: J
authors.lastname: Leon-Villapalos
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000465:Algorithms; D002053:Burn Units; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D004643:Emollients / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012828:Silicones / Q000627:therapeutic use; D017192:Skin Diseases, Bacterial / Q000517:prevention & control; D016038:Skin Transplantation; D013262:Stevens-Johnson Syndrome / Q000145:classification* / Q000628:therapy*; D006113:United Kingdom
chemical_list: C042816:Biobrane; D020099:Coated Materials, Biocompatible; D004643:Emollients; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D012828:Silicones; C114834:mepitel; D016572:Cyclosporine
keywords: Grading; Steven–Johnson syndrome; TEN; Toxic epidermal necrolysis syndrome; Wound care; Wound management