Skip to main content
SpringerLink
Log in

Initial ICU Management of Skin Sloughing Diseases: Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome

  • Conference paper
Yearbook of Intensive Care and Emergency Medicine

Part of the book series: Yearbook of Intensive Care and Emergency Medicine ((YEARBOOK,volume 2008))

  • 1130 Accesses

Abstract

Case Presentation: A 48 year old woman with metastatic breast cancer develops signs of an upper respiratory infection, fever, and malaise two weeks after starting dilantin for seizures from brain metastases. In the ensuing 48 hours, she develops skin eruptions on her face, which progress to her upper extremities and trunk. She develops lesions of the mouth as well as bullae over her trunk and extremities. She is admitted to the intensive care unit (ICU) hypotensive, tachycardic, and acidotic with sloughing of the skin of her head, trunk, both arms, and legs.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Lyell A (1956) Toxic epidermal necrolysis: an eruption resembling scalding of the skin. Br J Dermatol 68:355–361

    Article  CAS  PubMed  Google Scholar 

  2. Becker DS. (1998) Toxic epidermal necrolysis. Lancet 351:1417–1420

    Article  CAS  PubMed  Google Scholar 

  3. Chan HC, Stern RS, Arndt KA, et al (1990) The incidence of erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. Arch Dermatol 126:43–47

    Article  CAS  PubMed  Google Scholar 

  4. French LE (2006) Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome: our current understanding. Allergol Int 55:9–16

    Article  PubMed  Google Scholar 

  5. Roujeau JC (1994) The spectrum of Stevens-Johnson Syndrome and toxic epidermal necrolysis: A clinical classification. J Invest Dermatol 102:28S–30S

    Article  CAS  PubMed  Google Scholar 

  6. Correla O, Chosidow O, Saiag P, et al (1993) Evolving patterns of drug-induced toxic epidermal necrolysis. Dermatology 186:32–37

    Article  Google Scholar 

  7. Heimbach DM, Engrav LH, Marvin JA, Harnar TJ, Grube BJ (1987) Toxic epidermal necrolysis: a step forward in the treatment. JAMA 257:2171–2175

    Article  CAS  PubMed  Google Scholar 

  8. Kelemen JJ 3rd, Cioffi WC, McManus WF, Mason AD Jr, Pruitt B Jr (1995) Burn Center care for patients with toxic epidermal necrolysis. J Am Coll Surg 180:273–278

    PubMed  Google Scholar 

  9. Zoltie N, Verlende P, O’Neill TJ, Mc Kenzie AW (1994) Lyell’s syndrome on a burns unit. Burns 20:368–370

    Article  CAS  PubMed  Google Scholar 

  10. Palmieri TL, Greenhalgh DG, Saffle JR, et al (2002) A multicenter review of toxic epidermal necrolysis treated in U.S. Burn Centers at the end of the twentieth century. J Burn Care Rehabil 23:87–96

    Article  CAS  PubMed  Google Scholar 

  11. Hermes B, Haas N, Henz BM (1996) Plasmapheresis and immunopathogenic aspects of toxic epidermal necrolysis. Hautarzt 47:749–753

    Article  CAS  PubMed  Google Scholar 

  12. Breathnach SM McGibbon DH, Ive FA, Black MM (1982) Carbamazepine and toxic epidermal necrolysis: report of three cases with histopathological observations. Clin Exp Dermatol 7:585–591

    Article  CAS  PubMed  Google Scholar 

  13. Peck GL, Elias PM, Graw RG Jr (1972) Graft-versus-host reaction and toxic epidermal necrolysis. Lancet 2:1151–1153

    Article  CAS  PubMed  Google Scholar 

  14. Viard I, Wehrli P, Bullani R, et al (1998) Inhibition of toxic epidermal necrolysis by blockade of CD95 with human intravenous immunoglobulin. Science 282:490–493

    Article  CAS  PubMed  Google Scholar 

  15. Rojeau JC, Kelly JP, Rzany B, et al (1995) Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. N Engl J Med 333:1600–1607

    Article  Google Scholar 

  16. Guillaume JF, Roujeau JC, Revuz J, et al (1987) The culprit drugs in 87 cases of toxic epidermal necrolysis (Lyell syndrome). Arch Dermatol 123:1166–1170

    Article  CAS  PubMed  Google Scholar 

  17. Halebian P, Corder V, Herndon D, Shires GT (1983) A burn center experience with toxic epidermal necrolysis. J Burn Care Rehabil 4:176–183

    Article  Google Scholar 

  18. Schulz JT, Sheridan RL, Ryan CM, MacKool B, Tompkins RG (2000) A 10-year experience with toxic epidermal necrolysis. J Burn Care Rehabil 21:199–204

    Article  CAS  PubMed  Google Scholar 

  19. Wahle D, Beste D, Conley SF (1992) Laryngeal involvement in toxic epidermal necrolysis. Otolaryngol Head Neck Surg 6:796–799

    Google Scholar 

  20. Lebargy F, Wolkenstein P, Gisselbrecht M, et al (1997) Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study. Intensive Care Med 23:1237–1244

    Article  CAS  PubMed  Google Scholar 

  21. Wilkins J, Morrison L, White CR (1990) Oculocutaneous manifestations of the erythema multiforme/ Stevens-Johnson syndrome: descriptive and therapeutic controversy. Chest 98:331–336

    Article  Google Scholar 

  22. Marvin JA, Heimbach DM, Engrav LH, Harnar TJ (1984) Improved treatment of the Stevens-Johnson syndrome. Arch Surg 119:601–605

    CAS  PubMed  Google Scholar 

  23. McGee T, Munster A (1998) Toxic epidermal necrolysis syndrome: mortality rate reduced with early referral to a regional burn center. Plast Reconstr Surg 102:1018–1022

    Article  CAS  PubMed  Google Scholar 

  24. Bradley T, Brown RE, Kucan JO, Smoot EC, Hussmann J (1995) Toxic epidermal necrolysis: a review and report of the successful use of Biobrane for early wound coverage. Ann Plast Surg 35:124–132

    Article  CAS  PubMed  Google Scholar 

  25. Birchall N, Langdon R, Cuono C, McGuire J (1987) Toxic epidermal necrolysis: an approach to management using cryopreserved allograft skin. J Am Acad Dermatol 16:368–372

    Article  CAS  PubMed  Google Scholar 

  26. Halebian PH, Madden MR, Finkestein JL, et al (1986) Improved burn center survival of patients with toxic epidermal necrolysis managed without corticosteroids. Ann Surg 204:503–511

    Article  CAS  PubMed  Google Scholar 

  27. Engelhardt SL, Schurr MJ, Helgerson RB (1997) Toxic epidermal necrolysis: an analysis of referral patterns and steroid usage. J Burn Care Rehabil 18:520–524

    Article  CAS  PubMed  Google Scholar 

  28. Prins C, Vittorio C, Padillar S, Hunzikar P et al (2003) Effect of high-dose intravenous immunoglobulin therapy in Stevens-Johnson Syndrome: A retrospective, multicenter study. Dermatology 207:96–99

    Article  CAS  PubMed  Google Scholar 

  29. Brown KM, Silver GM, Halerz M, et al (2004) Toxic epidermal necrolysis: does immunoglobulin make a difference? J Burn Care Rehabil 25:81–88

    Article  CAS  PubMed  Google Scholar 

  30. Bachot N, Revuz J, Roujeau JC (2003) Intravenous immunoglobulin treatment for Stevens-Johnson syndrome and toxic epidermal necrolysis: a prospective noncomparative study showing no benefit on mortality or progression. Arch Dermatol 139:33–36

    Article  CAS  PubMed  Google Scholar 

  31. Renfro L, Grant-Kels JM, Daman LA (1989) Drug-induced toxic epidermal necrolysis treated with cyclosporine. Int J Dermatol 28:441–444

    Article  CAS  PubMed  Google Scholar 

  32. Egan C, Grant W, Morris S, Saffle J, Zone J (1999) Plasmapheresis as an adjunct treatment in toxic epidermal necrolysis. J Am Acad Dermatol 40:458–461

    Article  CAS  PubMed  Google Scholar 

  33. Bastuji-Garin S, Fouchard N, Bertocchi M, Roujeau JC, Revuz J, Wolkenstein P. (2000) SCORTEN: a severity-of-illness score for toxic epidermal necrolysis. J Invest Dermatol 115:149–153

    Article  CAS  PubMed  Google Scholar 

  34. Trent JT, Kirsner RS, Romanelli P, Kerdel FA (2004) Use of SCORTEN to accurately predict mortality in patients with toxic epidermal necrolysis in the United States. Arch Dermatol 140:890–892

    Article  PubMed  Google Scholar 

  35. Spies M, Hollyoak M, Muller MJ, Goodwin CW, Herndon DN (2000) Exfoliative and necrotizing diseases of the skin. In: Herndon DN (ed) Total Burn Care, 2nd edn. W.B.Saunders, New York, pp 492–496

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept of Surgery, UC Davis Regional Burn Center and Shriners Hospital for Children, 2425 Stockton Blvd., Suite 718, Sacramento, CA, 95817, USA

    T. L. Palmieri

Authors
  1. T. L. Palmieri
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Palmieri, T.L. (2008). Initial ICU Management of Skin Sloughing Diseases: Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome. In: Yearbook of Intensive Care and Emergency Medicine. Yearbook of Intensive Care and Emergency Medicine, vol 2008. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-77290-3_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-77290-3_15

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-77289-7

  • Online ISBN: 978-3-540-77290-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation