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Antishear Therapy for Toxic Epidermal Necrolysis: An Alternative Treatment Approach

Dorafshar, Amir H. M.B.Ch.B.; Dickie, Sara R. M.D.; Cohn, Alvin B. M.D.; Aycock, Joyce K. M.D.; O’Connor, Annemarie M.S.N., R.N.; Tung, Avery M.D.; Gottlieb, Lawrence J. M.D.

Plastic & Reconstructive Surgery: July 2008 - Volume 122 - Issue 1 - pp 154-160
doi: 10.1097/PRS.0b013e3181773d5d
Reconstructive: Trunk: Original Articles

Background: Toxic epidermal necrolysis syndrome is a devastating disease, with mortality rates ranging between 20 and 60 percent. This study evaluated an alternative treatment approach using antishear wound care and compared outcomes using the severity of illness score for toxic epidermal necrolysis syndrome (SCORTEN) system.

Methods: Records of 48 patients with a histopathologic diagnosis of toxic epidermal necrolysis syndrome treated with burn equivalent critical care and antishear wound care from September of 1985 to April of 2004 were reviewed. Observed mortality data were compared with those expected using the SCORTEN, and the standardized mortality ratio was calculated.

Results: The overall mortality rate was 27 percent. Factors affecting mortality were advancing age, time to burn unit admission, multisystem organ failure, and presence of comorbidities (p = 0.02, p = 0.02, p < 0.001, and p = 0.003, respectively). Chronic renal insufficiency and malignancy were two independent risk factors for nonsurvival (p = 0.04 and p = 0.004, respectively). Patients with a SCORTEN score of 2 or less had no mortality rate in this series. Observed and predicted mortality rates were comparable for patients with SCORTEN scores of 3 or greater. Patients with combined scores of 3 or less had a standardized mortality ratio score of 0.58 (42 percent mortality reduction). Overall, the standardized mortality ratio was 0.89 (11 percent mortality reduction).

Conclusions: Transfer to a burn intensive care unit and initiation of critical care and wound protocols similar to those used for burn patients are recommended for patients with toxic epidermal necrolysis syndrome. Antishear wound care provides an effective alternative wound care approach with equivalent mortality rates.

Chicago, Ill.

From the Section of Plastic and Reconstructive Surgery, Department of Surgery, and the Department of Anesthesia and Critical Care, University of Chicago.

Received for publication July 17, 2007; accepted October 16, 2007.

Presented at the Annual Meeting of the Midwestern Association of Plastic Surgeons, in Chicago, Illinois, April 20 through 21, 2006.

Lawrence Gottlieb, M.D.; Section of Plastic and Reconstructive Surgery; University of Chicago; 5841 South Maryland Avenue; MC 6035, Chicago, Ill. 60637; lgottlie@surgery.bsd.uchicago.edu

©2008American Society of Plastic Surgeons