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The Role of Biological Skin Substitutes in Stevens–Johnson Syndrome: Systematic Review

Paggiaro, André Oliveira, PhD; e Silva Filho, Markinokoff Lima; de Carvalho, Viviane Fernandes, PhD; Isaac, César, PhD; Gemperli, Rolf, PhD

doi: 10.1097/PSN.0000000000000234
Departments: Skin Care Department

Stevens–Johnson syndrome (SJS) is a disease that causes skin exfoliative lesions, characterized by fever, necrosis, and epidermal detachment. Biological skin substitutes may be considered interesting options for the treatment of this disease. This study aims at identifying in the literature the evidence on the current role of these biomaterials in the treatment of SJS and its related diseases. A systematic review with a search period between 2003 and 2017 was carried out, consulting the Lilacs, BVS, and PubMed databases. The quality of the included studies was evaluated by the Oxford Center for Evidence-Based Medicine Classification, for evaluating levels of evidence from the scientific publications. Ninety-five publications were found, and after applying inclusion and exclusion criteria, they resulted in 9 articles. In total, 20 patients with 73.87% average of body surface affected received SJS skin treatment with some biological substitutes, among them are cutaneous allograft, amnion, and xenograft. Mortality rate was 10%, and in these situations, literature indicates mortality rates ranging from 25% to 70%. Effectiveness of the use of biological dressings may be a possible explanation for this finding. Findings indicate the use of these biomaterials may favor reepithelialization, reduce water loss, decrease the chance of infection, and, consequently, improve the survival of patients with SJS and toxic epidermal necrolysis. Biological skin substitutes have characteristics that make them very promising in the topical treatment of these wounds, but their use remains very restricted in the treatment of SJS.

André Oliveira Paggiaro, PhD, is at Guarulhos University, Guarulhos, SP, Brazil.

Markinokoff Lima e Silva Filho, MN, is Nursing Postgraduation Student, Programa de Pós-Graduação em Enfermagem, Guarulhos University, Guarulhos, SP, Brazil.

Viviane Fernandes de Carvalho, PhD, is at Guarulhos University, Guarulhos, SP, Brazil.

César Isaac, PhD, is at São Paulo University, Sao Paulo, SP, Brazil.

Rolf Gemperli, PhD, is at São Paulo University, Sao Paulo, SP, Brazil.

Address correspondence to André Oliveira Paggiaro, PhD, Programa de Pós-Graduação em Enfermagem, Guarulhos University, Praça Tereza Cristina, 229, Centro, Guarulhos, SP, CEP: 07023-070, Brazil (e-mail:

The authors declare no conflicts of interest.

Copyright © 2018 by American Society of Plastic Surgical Nurses