Multidisciplinary Treatment in Toxic Epidermal Necrolysis

Area of Science:

• Dermatology
• Immunology
• Critical Care Medicine

Background:

• Toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous disease.
• Primarily caused by adverse drug reactions (approx. 90% of cases).
• Characterized by widespread epidermal necrosis affecting skin, mucosa, and epithelial linings.

Purpose of the Study:

• To review existing literature on TEN management.
• To propose unified treatment protocols for improved patient outcomes.
• To highlight the importance of early and multidisciplinary intervention.

Main Methods:

• Literature review of available scientific papers on TEN.
• Analysis of current diagnostic criteria (clinical and histopathological).
• Synthesis of evidence-based recommendations for systemic and topical treatment.

Main Results:

• Early drug withdrawal is crucial for initiating treatment.
• TEN management requires intensive care, similar to burn patients.
• Recommended supportive care includes fluid resuscitation, respiratory support, nutrition, pain control, infection/ulcer prophylaxis, and anticoagulation.
• Non-adherent dressings are key for local wound care.
• Systemic treatment focuses on eliminating the causative agent and immunomodulation.
• Combination therapy with plasmapheresis and IVIG is highly effective for serum purification.
• Immunomodulatory therapy demonstrated a five-fold reduction in mortality compared to immunosuppression or incomplete protocols.

Conclusions:

• Unified protocols and early, multidisciplinary management are essential for improving TEN patient outcomes.
• Intensive supportive care and specific treatments like plasmapheresis, IVIG, and immunomodulatory therapies are critical.
• Prompt recognition and intervention, starting with drug withdrawal, are paramount.