Manifestations Of Toxic Epidermal Necrolysis Research Articles

Integrating antimicrobial photodynamic therapy into the adjuvant phototherapeutic approach for orofacial manifestations of toxic epidermal necrolysis and Stevens-Johnson syndrome

Characterized by an immune reaction to medications, toxic epidermal necrolysis (TEN) and Steven-Johnson Syndrome (SJS) are potentially fatal mucocutaneous reactions, and their management remains challenging. Considering the promising studies regarding the use of laser in managing orofacial lesions, this study aimed to report two cases in which children presenting with TEN and SJS were treated using a combination of antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) concurrently with conventional supportive care. The treatment proposed herein resulted in significant clinical improvement of the children's oral condition within a few days, enabling the reintroduction of oral feeding. Within the limitations of the study, the cases reported suggest that the adjuvant combination of PBMT and aPDT may be beneficial for improving the oral condition of children afflicted with oral injuries induced by TEN and SJS.

Collagen-based biomaterials with possible therapeutic effects

Epidermolysis bullosa (EB) is a rare, serious genetic disease, incurable through the current means. Apart from this initial definition, there was later some ease in the definition of the disease, including the manifestations of toxic epidermal necrolysis and Stevens Johnson syndrome in this entity. In medical practice, there are cases that do not overlap with the description in the literature, thus the treatment must be adapted and personalized to the particularities. We present the case of a female new-born, with "de novo" mutation for the early-onset antenatal epidermolysis and our personalized therapeutic management, based on collagen from bovine corneas by enzymatic process. The histological examination showed that the collagen membranes serve as a support for the epithelial cells that formed a surface monolayer after 48 hours. Therefore. this case report shows that collagen-based biomaterials could be used to accelerate the dermal-epidermal healing in various conditions of the child, such as Stevens Johnson syndrome, bullous epidermolysis and widespread burns.

Oral Manifestations of Toxic Epidermal Necrolysis in A Pediatric Patient

Oral Manifestations of Toxic Epidermal Necrolysis in A Pediatric Patient

Efficacy and Limitation of Sutureless Amniotic Membrane Transplantation for Acute Toxic Epidermal Necrolysis

The purpose of this case report is to describe the efficacy and limitation of ProKera, a sutureless medical device containing amniotic membrane, for treating acute ocular manifestations of toxic epidermal necrolysis (TEN). ProKera was inserted in both eyes at day 10 after onset of ocular symptoms in a 5-year-old boy suffering from acute TEN, manifesting conjunctival inflammation, large conjunctival defects, pseudomembrane formation, and total corneal epithelial defects. At 9-month follow-up, insertion of ProKera resulted in complete reepithelialization, clear corneas, and vision of 20/20 in both eyes. However, because ProKera only covered the cornea and perilimbal conjunctiva, these 2 eyes still showed some conjunctival inflammation several months after discharge from the hospital. Eventually, 1 eye showed mild lid margin keratinization and cicatricial entropion, and both eyes showed trichiasis. These data suggest that ProKera, when inserted during the acute stage of TEN, may be effective in healing corneal epithelial defects and preventing corneal sequelae. Because of the limited area covered, ProKera may not prevent cicatricial complications in the fornix, tarsus, and eyelid margin as effectively as sutured amniotic membrane transplantation.

Hyperamylasemia in Toxic Epidermal Necrolysis

<h3>To the Editor.—</h3> Mucous membranes and systemic manifestations of toxic epidermal necrolysis (TEN) (also known as Lyell's syndrome) include oropharyngeal, ocular, genital, pulmonary, and intestinal involvement.^1,2Hyperamylasemia was reported in only a few cases and its origin, ie, salivary and/or pancreatic, remained controversial.^3,4The purpose of this study was to investigate the incidence and the origin of hyperamylasemia in TEN. <h3>Materials and Methods.—</h3> We reviewed retrospectively cases from 1985 through 1990 that fulfilled the criteria of TEN.¹Sixty-four patients with at least two determinations of amylase were included in the study. Amylase was assayed using the colorimetric method (α-amylase, Merck-Clevenot, Chelles, France) (normal, 50 to 220 U/L). Patients with hyperamylasemia (at least twice normal) were age and sex matched with patients without hyperamylasemia. These two groups of patients with TEN were compared for involvement of body surface area and mucous membranes, biological parameters (glycemia, serum aminotransferases levels,

Renal disease associated with toxic epidermal necrolysis (Lyell's disease)

A woman with toxic epidermal necrolysis and severe renal involvement is described. Serial renal biopsies were compatible with membranoproliferative glomerulonephritis. The pathophysiology and renal manifestations of toxic epidermal necrolysis are reviewed, and several previously unreported cases of toxic epidermal necrolysis with renal involvement are discussed. In several cases, changes were consistent with membranous or membranoproliferative glomerulonephritis, lending support to the concept of toxic epidermal necrolysis as an immunologic disease.

The Stevens-Johnson syndrome

A woman with toxic epidermal necrolysis and severe renal involvement is described. Serial renal biopsies were compatible with membranoproliferative glomerulonephritis. The pathophysiology and renal manifestations of toxic epidermal necrolysis are reviewed, and several previously unreported cases of toxic epidermal necrolysis with renal involvement are discussed. In several cases, changes were consistent with membranous or membranoproliferative glomerulonephritis, lending support to the concept of toxic epidermal necrolysis as an immunologic disease.