Toxic epidermal necrolysis

Advances in Skin & Wound Care,  Jan/Feb 2000  by Staley, Marlys J

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Toxic epidermal necrolysis Arevalo JM, Lorente JA. Skin coverage with Biobrane biomaterial for the treatment of patients with toxic epidermal necrolysis. J Burn Care Rehabil 1999;20:406-10.

ABSTRACT

Toxic epidermal necrolysis (TEN) is an exfoliative skin disorder that may involve a large body surface area and mucosal surfaces. The microscopic changes that occur with this condition are similar to those that occur with superficial dermal bums, such as dermal detachment from the underlying dermis. Complications of TEN are related to the loss of the epithelial skin barrier and include pain, fluid and electrolyte loss, and an increased risk of sepsis. The treatment of a patient with TEN is best accomplished in a bum unit, where expert treatment of these complications can be provided. Medical treatment includes the administration of immunosuppressive therapy and the discontinuation of any previous corticosteroid treatment. Surgical management includes the debridement of necrotic areas. In this article, the surgical management of 8 consecutive patients with TEN who were admitted to the intensive care burn unit at the Hospital Universitario de Getafe in Madrid, Spain, from 1996 to 1998 is described. These patients were treated with extensive early debridement of necrotic skin areas followed by wound coverage with Biobrane (Dow B. Hickam, Inc, Sugarland, Tex), a temporary semisynthetic skin substitute. Skin coverage with this material decreases pain and fluid loss, and it possibly facilitates epithelization and decreases the risk of sepsis, without adverse side effects. This semisynthetic material meets some standards of an ideal skin substitute: it is easy to use, provides several beneficial physiologic effects, and improves patient's comfort. In the 8 cases of patients with TEN that were studied, the use of Biobrane skin substitute for the coverage of massive areas of detached skin was found to be an important aspect of treatment.

COMMENTS

This article provides a quick overview oif toxic epidermal necrolysis (TEN) and a treatment alternative that was successful in a burn unit in Spain. It is important to note that the 25% to 80% mortality rate for this disease has declined over the past decade, primarily because patients with TEN are being cared for in specialized burn units by teams who are able to appropriately manage individuals with Large areas of skin loss. Use of Biobrane, a temporary skim substitute, ore 8 patients, demonstrated an improvement over previous treatment with topical antimicrobials. The skin substitute had benefits in cost, comfort, and availability over biologic dressings.

-Marlys J. Staley, MS, PT

May a ysJ. Staley, MS, PT, is a physical therapist its NovaCare Inc., Ciqcinnaft,OH. DK.ane K Langemo, PhD, RN atricia A.Thompson,MS, RN, and Darlene Hanson MS, RN, are from the University of North Da

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