Improved treatment of the Stevens-Johnson syndrome

The Stevens-Johnson syndrome (SJS), a disease resulting in greater than 30% body surface area epidermal and mucosal desquamation, is reported to have a mortality of greater than 50%. Recommended treatment has included steroids, prophylactic antibiotics, nutritional support, and application of topical antibacterials. Since the lesions represent only epidermal loss without dermal necrosis, rapid reepithelialization should occur if the dermis is protected from desiccation with a biological dressing. Five nonburned patients with severe SJS were treated in the University of Washington burn center, Seattle, with urgent operative debridement of their wounds and application of porcine xenograft immediately after admission. Steroid administration was stopped. Antibiotics were used only for culture-proved infections. All patients completely re-epithelialized within a mean of 18 days. There was one death, a 9-year-old boy who was completely re-epithelialized when sudden fatal sepsis that originated from a ventriculovenous shunt placed when he was an infant developed. In this group of patients, rapid wound closure with xenograft and supportive care permitted rapid reepithelialization and decreased mortality and morbidity.