title: Pediatric Toxic Epidermal Necrolysis: Experience of a Tertiary Burn Center.
abstract: BACKGROUND
  Pediatric toxic epidermal necrolysis (TEN) is a rare and potentially fatal skin disease with a multitude of causative factors and no consensus on treatment guidelines and, as a result, it has a variety of short- and long-term outcomes. We present the experience of a large specialty burn center to share our diagnostic and treatment principles.
  
  
  METHODS
  A retrospective review from 1989 to 2010 at the Joseph M. Still Burn Center was performed to find patients with a diagnosis of Steven-Johnson syndrome (SJS) or TEN. Information was obtained on demographic and physiologic parameters such as age, race, total body surface area involved, treatments, hospital stay, and need for ventilator support.
  
  
  RESULTS
  We identified SJS or TEN in 21 patients. Prescription drugs were the most common etiology (in 15 patients), with antibiotics as the most common causative agent. Histology confirmed the clinical diagnosis of TEN in 14 patients. Our treatment plan included a multidisciplinary team, early initiation of intravenous immunoglobulin, bronchoscopy, strict management of electrolyte and fluid balances, and meticulous surgical wound care. Mortality was 9.5%.
  
  
  CONCLUSIONS
  Our experience in treating this rare but devastating disease affords us the opportunity to share the diagnostic dilemmas we faced and the treatment principles we used to treat this unique patient population successfully.
authors.affiliation: Institute of Surgical Research, U.S. Army, Fort Sam Houston, Texas.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Rizzo
authors.affiliation: Department of Surgery, Dwight David Eisenhower Army Medical Center, Ft. Gordon, Georgia.
authors.forename: Rebekah
authors.initials: R
authors.lastname: Johnson
authors.affiliation: Pediatric Intensive Care Services, Joseph M. Still Burn Centers, Augusta, Georgia.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cartie
mesh_terms: D000293:Adolescent; D001999:Bronchoscopy; D002053:Burn Units; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007223:Infant; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis* / Q000188:drug therapy*; D062606:Tertiary Care Centers; D014882:Water-Electrolyte Balance
chemical_list: D016756:Immunoglobulins, Intravenous