Treatment of extensive toxic epidermal necrolysis in children

Marcus Spies, Arthur P. Sanford, J. F Aili Low, Steven Wolf, David Herndon

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Objective. Toxic epidermal necrolysis (TEN) is a rare but life-threatening disease of the skin and mucous membranes. We report our experience in the treatment of pediatric TEN patients with early debridement of necrotic skin and coverage with human allograft skin. Methods. From 1984 to 2000, 15 children (6 girls, 9 boys, 7.2 ± 1.5 years) with a histologic diagnosis of TEN and involvement of >30% total body surface area were treated at the Shriners Hospitals for Children in Galveston. All were treated in a specialized pediatric burn intensive care unit after our standard treatment protocol, including operative debridement of sloughing skin and allografting within 24 hours of admission. Outcome parameters were mortality, length of hospital stay, wound healing, clinical complications, causative drugs, corticosteroid use, and delay in referral to a burn center. Results. Taking a new medication (antibiotics, anticonvulsive drugs) was associated with all cases of TEN. Patients who were treated with early debridement and coverage with allograft skin showed no wound infection, and overall mortality was 7%. Total length of hospital stay was 26 ± 3 days. Long-term sequelae were changes in skin pigmentation (100%), ophthalmologic problems (40%), and diffuse itching early after wound healing (53%). Conclusion. Although a rare disease in children, TEN was managed successfully in a burn center environment, using early debridement and wound coverage with allograft skin as a biological dressing. The use of corticosteroids and referral patterns seems unchanged during the past 2 decades, indicating an additional need for information and education about the disease.

Original languageEnglish (US)
Pages (from-to)1162-1168
Number of pages7
JournalPediatrics
Volume108
Issue number5
DOIs
StatePublished - 2001

Fingerprint

Stevens-Johnson Syndrome
Debridement
Length of Stay
Skin
Allografts
Burn Units
Wound Healing
Adrenal Cortex Hormones
Biological Dressings
Referral and Consultation
Skin Pigmentation
Therapeutics
Pediatric Intensive Care Units
Mortality
Body Surface Area
Homologous Transplantation
Wound Infection
Pruritus
Clinical Protocols
Rare Diseases

Keywords

  • Biological dressing
  • Burn center
  • Children
  • Mortality
  • Toxic epidermal necrolysis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Spies, M., Sanford, A. P., Low, J. F. A., Wolf, S., & Herndon, D. (2001). Treatment of extensive toxic epidermal necrolysis in children. Pediatrics, 108(5), 1162-1168. https://doi.org/10.1542/peds.108.5.1162

Treatment of extensive toxic epidermal necrolysis in children. / Spies, Marcus; Sanford, Arthur P.; Low, J. F Aili; Wolf, Steven; Herndon, David.

In: Pediatrics, Vol. 108, No. 5, 2001, p. 1162-1168.

Research output: Contribution to journalArticle

Spies, M, Sanford, AP, Low, JFA, Wolf, S & Herndon, D 2001, 'Treatment of extensive toxic epidermal necrolysis in children', Pediatrics, vol. 108, no. 5, pp. 1162-1168. https://doi.org/10.1542/peds.108.5.1162
Spies, Marcus ; Sanford, Arthur P. ; Low, J. F Aili ; Wolf, Steven ; Herndon, David. / Treatment of extensive toxic epidermal necrolysis in children. In: Pediatrics. 2001 ; Vol. 108, No. 5. pp. 1162-1168.
@article{f92f8a3f1c9343dd8ac7633649a8d4d1,
title = "Treatment of extensive toxic epidermal necrolysis in children",
abstract = "Objective. Toxic epidermal necrolysis (TEN) is a rare but life-threatening disease of the skin and mucous membranes. We report our experience in the treatment of pediatric TEN patients with early debridement of necrotic skin and coverage with human allograft skin. Methods. From 1984 to 2000, 15 children (6 girls, 9 boys, 7.2 ± 1.5 years) with a histologic diagnosis of TEN and involvement of >30{\%} total body surface area were treated at the Shriners Hospitals for Children in Galveston. All were treated in a specialized pediatric burn intensive care unit after our standard treatment protocol, including operative debridement of sloughing skin and allografting within 24 hours of admission. Outcome parameters were mortality, length of hospital stay, wound healing, clinical complications, causative drugs, corticosteroid use, and delay in referral to a burn center. Results. Taking a new medication (antibiotics, anticonvulsive drugs) was associated with all cases of TEN. Patients who were treated with early debridement and coverage with allograft skin showed no wound infection, and overall mortality was 7{\%}. Total length of hospital stay was 26 ± 3 days. Long-term sequelae were changes in skin pigmentation (100{\%}), ophthalmologic problems (40{\%}), and diffuse itching early after wound healing (53{\%}). Conclusion. Although a rare disease in children, TEN was managed successfully in a burn center environment, using early debridement and wound coverage with allograft skin as a biological dressing. The use of corticosteroids and referral patterns seems unchanged during the past 2 decades, indicating an additional need for information and education about the disease.",
keywords = "Biological dressing, Burn center, Children, Mortality, Toxic epidermal necrolysis",
author = "Marcus Spies and Sanford, {Arthur P.} and Low, {J. F Aili} and Steven Wolf and David Herndon",
year = "2001",
doi = "10.1542/peds.108.5.1162",
language = "English (US)",
volume = "108",
pages = "1162--1168",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "5",

}

TY - JOUR

T1 - Treatment of extensive toxic epidermal necrolysis in children

AU - Spies, Marcus

AU - Sanford, Arthur P.

AU - Low, J. F Aili

AU - Wolf, Steven

AU - Herndon, David

PY - 2001

Y1 - 2001

N2 - Objective. Toxic epidermal necrolysis (TEN) is a rare but life-threatening disease of the skin and mucous membranes. We report our experience in the treatment of pediatric TEN patients with early debridement of necrotic skin and coverage with human allograft skin. Methods. From 1984 to 2000, 15 children (6 girls, 9 boys, 7.2 ± 1.5 years) with a histologic diagnosis of TEN and involvement of >30% total body surface area were treated at the Shriners Hospitals for Children in Galveston. All were treated in a specialized pediatric burn intensive care unit after our standard treatment protocol, including operative debridement of sloughing skin and allografting within 24 hours of admission. Outcome parameters were mortality, length of hospital stay, wound healing, clinical complications, causative drugs, corticosteroid use, and delay in referral to a burn center. Results. Taking a new medication (antibiotics, anticonvulsive drugs) was associated with all cases of TEN. Patients who were treated with early debridement and coverage with allograft skin showed no wound infection, and overall mortality was 7%. Total length of hospital stay was 26 ± 3 days. Long-term sequelae were changes in skin pigmentation (100%), ophthalmologic problems (40%), and diffuse itching early after wound healing (53%). Conclusion. Although a rare disease in children, TEN was managed successfully in a burn center environment, using early debridement and wound coverage with allograft skin as a biological dressing. The use of corticosteroids and referral patterns seems unchanged during the past 2 decades, indicating an additional need for information and education about the disease.

AB - Objective. Toxic epidermal necrolysis (TEN) is a rare but life-threatening disease of the skin and mucous membranes. We report our experience in the treatment of pediatric TEN patients with early debridement of necrotic skin and coverage with human allograft skin. Methods. From 1984 to 2000, 15 children (6 girls, 9 boys, 7.2 ± 1.5 years) with a histologic diagnosis of TEN and involvement of >30% total body surface area were treated at the Shriners Hospitals for Children in Galveston. All were treated in a specialized pediatric burn intensive care unit after our standard treatment protocol, including operative debridement of sloughing skin and allografting within 24 hours of admission. Outcome parameters were mortality, length of hospital stay, wound healing, clinical complications, causative drugs, corticosteroid use, and delay in referral to a burn center. Results. Taking a new medication (antibiotics, anticonvulsive drugs) was associated with all cases of TEN. Patients who were treated with early debridement and coverage with allograft skin showed no wound infection, and overall mortality was 7%. Total length of hospital stay was 26 ± 3 days. Long-term sequelae were changes in skin pigmentation (100%), ophthalmologic problems (40%), and diffuse itching early after wound healing (53%). Conclusion. Although a rare disease in children, TEN was managed successfully in a burn center environment, using early debridement and wound coverage with allograft skin as a biological dressing. The use of corticosteroids and referral patterns seems unchanged during the past 2 decades, indicating an additional need for information and education about the disease.

KW - Biological dressing

KW - Burn center

KW - Children

KW - Mortality

KW - Toxic epidermal necrolysis

UR - http://www.scopus.com/inward/record.url?scp=0034757065&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034757065&partnerID=8YFLogxK

U2 - 10.1542/peds.108.5.1162

DO - 10.1542/peds.108.5.1162

M3 - Article

C2 - 11694697

AN - SCOPUS:0034757065

VL - 108

SP - 1162

EP - 1168

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 5

ER -