Amy J Zhang1, Rachel M Nygaard2, Frederick W Endorf2, Sara A Hylwa3,4. 1. University of Minnesota Medical School, Minneapolis, MN, USA. 2. Department of Surgery, Hennepin County Medical Center, Minneapolis, MN, USA. 3. Department of Dermatology, University of Minnesota, Minneapolis, MN, USA. 4. Department of Dermatology, Hennepin County Medical Center, Minneapolis, MN, USA.
Abstract
BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous disorders. To date, relatively few studies have looked at institutional approaches to treatment of SJS/TEN, particularly with a focus on wound care. METHODS: A retrospective review was conducted on patients admitted to the Hennepin County Medical Center from 2007 to 2017 with a final diagnosis of SJS or TEN. Data were obtained for demographics, causative drug, hospital course, supportive care, medical management, complications, and disposition. RESULTS: A total of 48 were diagnosed with SJS/TEN during the study period. A total of 41.7% (20/48) were men, and the mean age was 49.2 years. Sulfa antibiotics and nonsulfa antibiotics were the most common causative drug categories, each accounting for a quarter of cases. Supportive measures included intravenous fluid resuscitation in 4.2% of cases, enteral nutrition in 75%, surgical debridement in 27.1%, and porcine xenograft in 16.7%. Wound care consisted of use of a cleanser in 95.8% of patients, topical antibiotic in 95.8%, topical steroid in 20.8%, topical antifungal in 14.6%, emollient in 83.3%, nonadherent dressing in 97.9%, silver impregnated dressing in 39.6%, nonsilver impregnated dressing in 79.2%, and general wrap in 93.8%. For medical treatment, 64.6% of patients received intravenous immunoglobulin (IVIG), and 8.3% of patients received cyclosporine. Mortality rate was 12.5% overall, compared to an expected mortality rate of 25.2% as predicted by SCORTEN. CONCLUSIONS: Patients treated with our current regimen of care showed a mortality rate half of that predicted by SCORTEN.
BACKGROUND:Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous disorders. To date, relatively few studies have looked at institutional approaches to treatment of SJS/TEN, particularly with a focus on wound care. METHODS: A retrospective review was conducted on patients admitted to the Hennepin County Medical Center from 2007 to 2017 with a final diagnosis of SJS or TEN. Data were obtained for demographics, causative drug, hospital course, supportive care, medical management, complications, and disposition. RESULTS: A total of 48 were diagnosed with SJS/TEN during the study period. A total of 41.7% (20/48) were men, and the mean age was 49.2 years. Sulfa antibiotics and nonsulfa antibiotics were the most common causative drug categories, each accounting for a quarter of cases. Supportive measures included intravenous fluid resuscitation in 4.2% of cases, enteral nutrition in 75%, surgical debridement in 27.1%, and porcine xenograft in 16.7%. Wound care consisted of use of a cleanser in 95.8% of patients, topical antibiotic in 95.8%, topical steroid in 20.8%, topical antifungal in 14.6%, emollient in 83.3%, nonadherent dressing in 97.9%, silver impregnated dressing in 39.6%, nonsilver impregnated dressing in 79.2%, and general wrap in 93.8%. For medical treatment, 64.6% of patients received intravenous immunoglobulin (IVIG), and 8.3% of patients received cyclosporine. Mortality rate was 12.5% overall, compared to an expected mortality rate of 25.2% as predicted by SCORTEN. CONCLUSIONS:Patients treated with our current regimen of care showed a mortality rate half of that predicted by SCORTEN.
Authors: Liqin Wang; Sheril Varghese; Fatima Bassir; Ying-Chin Lo; Carlos A Ortega; Sonam Shah; Kimberly G Blumenthal; Elizabeth J Phillips; Li Zhou Journal: Front Med (Lausanne) Date: 2022-08-24