Toxic epidermal necrolysis: Use of Biobrane ® for skin coverage reduces pain, improves mobilisation and decreases infection in elderly patients

Abstract

Introduction Toxic epidermal necrolysis is a rare disease with high mortality due to generalised infection, sepsis or lung involvement, and requires discontinuation of all potentially triggering medications and intensive care in a specialised burn centre. Apart from wound care with antiseptics, wound coverage may be achieved with a skin substitute; treatments are compared with regard to infection, protein loss, re-epithelialisation and mortality. Patients and methods Of 14 people with toxic epidermal necrolysis affecting >30% body surface area, eight received daily dressing changes using Lavasept ® and six received wound coverage with Biobrane ®. Demographic data, SCORTEN score, mortality, visual-analog pain scale, mobilisation, time to re-epithelialisation, serum protein, albumin, C-reactive protein and leukocytes, and body temperature were evaluated in all cases. Results Mean age of patients was 68.0 ± 14.8 years, mean body surface area affected was 66.4%, median SCORTEN score was three and overall mortality was 36%. In the Biobrane ® compared with the Lavasept ® (control) group, mean pain was significantly reduced (2.9 versus 5.5 on the scale, p < 0.05), mobilisation was significantly earlier (walking at 3 days versus 7 days, p = 0.003), re-epithelialisation was complete in 12.5 days versus 16 days, and at 9 days there was reduced decrease of serum proteins and significantly lower levels of C-reactive protein and white cells ( p < 0.05). Conclusion Early wound coverage with synthetic skin substitute such as Biobrane ® is beneficial compared with conservative antiseptic wound treatment, but mortality rate is not significantly different.