Management of toxic epidermal necrolysis in a pediatric burn center

Toxic epidermal necrolysis (TEN) is an acute severe exfoliative skin and mucosal membrane disorder with a clinical picture similar to a total-body scald injury. Toxic epidermal necrolysis shares features with severe erythema multiforme seen in Stevens-Johnson syndrome, and is thought by some to be a maximal expression of this syndrome. Drug-related TEN is uncommon in children. Mortalities of 70% have been reported, and death is usually secondary to the bacterial and metabolic consequences of a large open wound. Over the past two years, four children with probable drug-induced TEN were treated successfully. Since the problems of infection, wound care, fluid balance, nutrition, and pain control are similar in TEN and major burn patients, treatment using the principles of burn care may improve survival.