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

Abstract

Toxic epidermal necrolysis (TEN) is the most severe form of the Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) spectrum. It is characterized by epidermal exfoliation and nucositis 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.