Toxic epidermal necrolysis: Management in the ICU

Area of Science:

• Dermatology
• Intensive Care Medicine
• Pharmacovigilance

Background:

• Epidermal necrolysis (EN), encompassing Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), represents a rare but severe adverse drug reaction.
• These conditions are characterized by widespread detachment of the epidermis, with SJS affecting <10% and TEN ≥30% of body surface area.
• Drug exposure, accounting for 85-90% of cases, typically precedes the onset of symptoms within 4-28 days.

Purpose of the Study:

• This review focuses on the critical management strategies for EN during the acute phase within intensive care units.
• It aims to consolidate current knowledge on supportive care and pharmacological interventions for SJS and TEN.
• Emphasis is placed on management within expert centers, including burn units.

Main Methods:

• Review of current literature on the management of epidermal necrolysis.
• Synthesis of information regarding supportive care protocols in intensive care settings.
• Analysis of available pharmacological interventions and their efficacy.

Main Results:

• The acute phase of EN is life-threatening, with respiratory and septic complications significantly impacting prognosis.
• Mortality rates for EN average between 15-20%.
• Current evidence suggests no immunomodulatory treatment effectively halts epidermal detachment or reduces mortality.

Conclusions:

• Prompt withdrawal of the suspected causative drug is paramount in managing EN.
• Supportive care is the cornerstone of treatment, necessitating multidisciplinary management in specialized centers.
• Optimal outcomes for patients with SJS and TEN depend on expert care, often within intensive care or burn units.