Stevens-Johnson syndrome and toxic epidermal necrolysis: retrospective review of 10-year experience.

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous disorders. To date, relatively few studies have looked at institutional approaches to treatment of SJS/TEN, particularly with a focus on wound care. A retrospective review was conducted on patients admitted to the Hennepin County Medical Center from 2007 to 2017 with a final diagnosis of SJS or TEN. Data were obtained for demographics, causative drug, hospital course, supportive care, medical management, complications, and disposition. A total of 48 were diagnosed with SJS/TEN during the study period. A total of 41.7% (20/48) were men, and the mean age was 49.2 years. Sulfa antibiotics and nonsulfa antibiotics were the most common causative drug categories, each accounting for a quarter of cases. Supportive measures included intravenous fluid resuscitation in 4.2% of cases, enteral nutrition in 75%, surgical debridement in 27.1%, and porcine xenograft in 16.7%. Wound care consisted of use of a cleanser in 95.8% of patients, topical antibiotic in 95.8%, topical steroid in 20.8%, topical antifungal in 14.6%, emollient in 83.3%, nonadherent dressing in 97.9%, silver impregnated dressing in 39.6%, nonsilver impregnated dressing in 79.2%, and general wrap in 93.8%. For medical treatment, 64.6% of patients received intravenous immunoglobulin (IVIG), and 8.3% of patients received cyclosporine. Mortality rate was 12.5% overall, compared to an expected mortality rate of 25.2% as predicted by SCORTEN. Patients treated with our current regimen of care showed a mortality rate half of that predicted by SCORTEN.