Topical treatment options for drug-induced toxic epidermal necrolysis (TEN).

IMPORTANCE OF THE FIELD: Drug-induced toxic epidermal necrolysis (TEN) is a dreadful skin condition. The mortality rate of 25 - 30% is mainly due to both metabolic failures and septicemia following loss of epidermal integrity. Topical treatments are important options in these patients. AREAS COVERED IN THIS REVIEW: Topical TEN care includes specific bedding, debridement of epidermal necrosis, applications of bioactive skin substitutes or semi-synthetic and synthetic dressings, as well as antiseptic and antibiotic agents. WHAT THE READER WILL GAIN: In the early exudating phase of TEN, the use of airfluidized bed combined with gentle debridement are recommended. Next, an alternating pressure mattress and silver impregnated absorbent dressings should be used. During the re-epithelialization phase, antiseptic or antibiotic creams overlaid with nonadherent dressings favor an optimized moist and bacteria-controlled environment. TAKE HOME MESSAGE: A suitable topical treatment is mandatory in TEN. Skin care procedures must be managed according to the skin condition corresponding to the initial highly exudating/necrotic phase, the secondary moderately exudating stabilized phase and the later re-epidermization phase. Bedding modalities, debridement procedures, applications of bioactive, semi-synthetic and synthetic dressings (silver-impregnated or not) and antiseptic/antibiotic creams should be adapted accordingly.