Stevens-Johnson syndrome/toxic epidermal necrolysis management in the burn intensive care unit: A case series

Abstract

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis comprise a spectrum of severe hypersensitivity skin reactions. Stevens-Johnson Syndrome is the least severe on the spectrum of mucosal erosions, with Toxic Epidermal Necrolysis being the most severe. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis is a disease of keratinocytes and therefore any squamous cell epithelium is at risk. This includes the cornea, conjunctiva, oral mucosa, esophagus, urethra, and anal canal. This skin reaction is typically drug-induced and has a very poor prognosis. We present four different Stevens-Johnson Syndrome patients who managed solely in the burn intensive care unit at our facility. The mainstay of treatment included supportive care with an emphasis on fluid and electrolyte replacement. Transfer of patients to the burn unit is not the current standard of care, however could decrease the mortality and morbidity of patients. As seen in our centers burn intensive care unit patients only had a mortality rate of 17% over 5 years. Management of Stevens-Johnson Syndrome in the burn intensive care unit with a comprehensive interdisciplinary wound care team rather than solely dermatological intervention may improve outcomes.