Toxic epidermal necrolysis in a burns centre: a 6-year review

Toxic epidermal necrolysis (TEN) is the most severe of the Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) spectrum. It is characterized by epidermal exfoliation and mucositis and carries an average mortality of 25 per cent. In this 6-year retrospective study, we reviewed 23 patients with drug-induced SJS-TEN. The most common causative agents were anticonvulsants and traditional medication. The mean time of onset of symptoms was 4.1 days (range 1-16 days) and the mean body surface area involved was 57.2 per cent (range 30-90 per cent). The condition was most commonly associated with ocular complications and sepsis. Using our treatment protocol in a burns centre, we were able to achieve a mean time to complete healing of 20.2 days (range 7-53 days) and a mean duration of hospitalization of 34.1 days (range 7-134 days). The length of hospital stay was prolonged when non-ocular complications supervened. The percentage mortality in our series was 10 per cent. It is our contention that the best results are obtained with treatment of the SJS-TEN patient in a burns centre with an internist, dermatologist and infectious disease specialist as part of the management team.