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A 10-year experience with toxic epidermal necrolysis
J T Schulz1, R L Sheridan, C M Ryan
1Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston 02114-2696, USA.
The Journal of Burn Care & Rehabilitation
|June 13, 2000
Summary
Age, delayed hospitalization, and low platelet counts are key indicators of poor outcomes in toxic epidermal necrolysis (TEN). Early treatment and prompt medical attention significantly improve survival rates for this severe drug-induced skin reaction.
Area of Science:
- Dermatology
- Pharmacology
- Critical Care Medicine
Background:
- Toxic epidermal necrolysis (TEN) is a severe, life-threatening drug-induced skin reaction characterized by widespread epidermal detachment.
- Previous studies indicated age, delayed referral, body surface area (TBSA) involvement, and systemic steroid use as poor prognostic factors in TEN.
- The mortality rate for TEN ranges from 30% to 60% in adults, highlighting the need for accurate prognostic indicators.
Purpose of the Study:
- To identify clinical characteristics and patient factors associated with mortality in adult patients with extensive TEN.
- To re-evaluate the prognostic significance of previously suggested indicators and explore new correlates of mortality in a burn center setting.
Main Methods:
- Retrospective review of 39 adult patients with >20% TBSA epithelial necrosis treated for TEN between January 1987 and March 1998.
- Analysis of 28 clinical characteristics to identify correlations with mortality using single analysis of variance.
- Wound management involved topical antimicrobials and porcine xenografts in a controlled nursing unit.
Main Results:
- The overall mortality rate was 44% (17 of 39 patients), with multiple-organ dysfunction syndrome as the primary cause of death.
- Survivors were significantly younger (47.5 vs. 64.5 years), had shorter delays to hospitalization (3.5 vs. 5.9 days), and less frequent early thrombocytopenia (platelet nadir 154 vs. 70).
- Unlike previous reports, TBSA involvement and systemic steroid treatment were not significantly related to mortality in this cohort; early antibiotic treatment before referral was associated with a poorer prognosis.
Conclusions:
- In older patients with extensive TEN, age, delayed hospitalization, and early thrombocytopenia are significant predictors of mortality.
- Early empiric antibiotic treatment prior to specialized care may be associated with adverse outcomes.
- These findings underscore the importance of timely presentation to specialized centers for optimal management of severe cutaneous adverse drug reactions like TEN.