Toxic epidermal necrolysis: management strategies in burns units.

IF 1.5 4区医学 Q3 DERMATOLOGY Journal of wound care Pub Date : 2024-12-02 DOI:10.12968/jowc.2021.0063

Iker Miguel Escuredo, Laura Cabañas Weisz, Javier Vásquez Manau, Juan Bautista Ayestarán Soto, Jesus Gardeazabal García

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Abstract

Objective: The most common severe exfoliative condition is toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, for which patients may sometimes require admission to hospital burns units. This study analyses the experience of the authors and results in this condition at the Cruces University Hospital in Bilbao, Spain.

Method: Over the last 22 years, the authors carried out a retrospective analytical observational study of TEN cases at the hospital and analysed risk factors including age, associated comorbidities, percentage of body surface area affected, positive bacterial culture, and treatment strategies used to assess their potential influence on prognosis.

Results: The results indicated an association between mortality and age (ρ (rho)=0.60, 95% CI [0.29, 0.79], p<0,001), ocular (ρ=0.58, 95% CI [0.28, 0.78], p<0.001), oropharyngeal (ρ=0.64, 95% CI [0.36, 0.81], p<0.001), genitourinary (ρ=0.58 CI [0.28, 0.78], p<0.001) respiratory mucosa involvement (ρ=0.53, 95 % CI [0.28, 0.78], p<0.001) and bacteraemia (ρ=0.44, 95% CI [0.17, 0.64], p=0.020). Bacteraemia also showed a higher incidence in elderly patients (ρ=0.4, 95% CI [0.03, 0.67], p=0.033) and in those with a higher Score for Toxic Epidermal Necrolysis at admission (ρ=0.51, CI [0.17, 0.74], p=0.006). A reduction in mortality was found in patients who received systemic treatment; cyclosporine, etanercept or a combination of both (ρ=-0.44, Cl [-0.70, -0.09], p=0.018).

Conclusion: TEN is a rare but serious exfoliative condition. Traditionally, management of denuded skin was seen as the main prognostic factor; yet, systemic damage, especially to the respiratory mucosa, significantly increases mortality risk. While life support is crucial and recovery is possible, preventing long-term sequelae relies on effective care protocols. Current treatments may offer benefits, though their efficacy remains unclear. Clinicians in burns units should develop standardised protocols and collaborate on long-term studies to enhance patient care.

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中毒性表皮坏死松解：烧伤单位的管理策略。

目的：最常见的严重剥脱状况是中毒性表皮坏死松解（TEN），也称为莱尔综合征，患者有时可能需要住院烧伤。本研究分析了作者在西班牙毕尔巴鄂克鲁塞斯大学医院治疗这种疾病的经验和结果。方法：在过去的22年中，作者对医院的10例病例进行了回顾性分析观察研究，并分析了危险因素，包括年龄、相关合并症、受影响的体表面积百分比、阳性细菌培养和用于评估其对预后的潜在影响的治疗策略。结果：死亡率与年龄相关(ρ (rho)=0.60, 95% CI[0.29, 0.79]，结论：TEN是一种罕见但严重的剥脱性疾病。传统上，脱皮的处理被视为主要的预后因素；然而，全身性损伤，尤其是呼吸道粘膜损伤，会显著增加死亡风险。虽然生命支持至关重要，康复是可能的，但预防长期后遗症依赖于有效的护理方案。目前的治疗方法可能会带来好处，尽管其疗效尚不清楚。烧伤单位的临床医生应该制定标准化的方案，并在长期研究上进行合作，以提高患者的护理水平。

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来源期刊

Journal of wound care DERMATOLOGY-

CiteScore

2.90

自引率

10.50%

发文量

215

期刊介绍： Journal of Wound Care (JWC) is the definitive wound-care journal and the leading source of up-to-date research and clinical information on everything related to tissue viability. The journal was first launched in 1992 and aimed at catering to the needs of the multidisciplinary team. Published monthly, the journal’s international audience includes nurses, doctors and researchers specialising in wound management and tissue viability, as well as generalists wishing to enhance their practice. In addition to cutting edge and state-of-the-art research and practice articles, JWC also covers topics related to wound-care management, education and novel therapies, as well as JWC cases supplements, a supplement dedicated solely to case reports and case series in wound care. All articles are rigorously peer-reviewed by a panel of international experts, comprised of clinicians, nurses and researchers. Specifically, JWC publishes: High quality evidence on all aspects of wound care, including leg ulcers, pressure ulcers, the diabetic foot, burns, surgical wounds, wound infection and more The latest developments and innovations in wound care through both preclinical and preliminary clinical trials of potential new treatments worldwide In-depth prospective studies of new treatment applications, as well as high-level research evidence on existing treatments Clinical case studies providing information on how to deal with complex wounds Comprehensive literature reviews on current concepts and practice, including cost-effectiveness Updates on the activities of wound care societies around the world.