Abstract
Purpose of Review
Stevens-Johnson syndrome and toxic epidermal necrolysis are severe mucocutaneous drug reactions associated with a potentially high mortality rate. They are characterized by epidermal necrosis and extensive detachment. For these reasons, wound care is a fundamental component of patient management. However, there is a lack of evidence-based data, and treatment approaches can vary drastically between institutions. Our aim was to analyze the available studies on this topic as an attempt to review various management strategies.
Recent Findings
Considering the rarity, variable presentations, and difficulty to prospectively study patients with SJS/TEN, there is a lack of evidence-based data on the topic of wound management. We reviewed the most recently published guidelines, expert opinions, and other studies from different countries and hospital centers.
Summary
There is a great variability in the utilization of antiseptic agents, wound dressing types, and implementation of surgical debridement across the globe and different institutions. There is a lack of randomized controlled trials. However, the general principle is to protect the underlying viable exposed dermis, minimize the risk of infection, reduce the risk of pigmentary changes and scarring, and optimize the conditions for re-epithelization. Large-scale randomized clinical trials are needed for the optimization of wound care in these conditions.
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References
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Hotzenecker W, Prins C, French LE. Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. In: Bolognia JL, Jorizzo JL, Schaffer JV, editors. Dermatology (Basel, Switzerland). Philadelphia: Elsevier Saunders; 2018. p. 332–47.
Hsu DY, Brieva J, Silverberg NB, Silverberg JI. Morbidity and mortality of Stevens-Johnson syndrome and toxic epidermal necrolysis in United States adults. J Invest Dermatol. 2016;136(7):1387–97.
Frey N, Jossi J, Bodmer M, Bircher A, Jick SS, Meier CR, et al. The epidemiology of Stevens-Johnson syndrome and toxic epidermal necrolysis in the UK. J Invest Dermatol. 2017;137(6):1240–7.
Downey A, Jackson C, Harun N, Cooper A. Toxic epidermal necrolysis: review of pathogenesis and management. J Am Acad Dermatol. 2012;66(6):995–1003.
Schwartz RA, McDonough PH, Lee BW. Toxic epidermal necrolysis: Part I. Introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis. J Am Acad Dermatol. 2013;69(2):173.e1–13 quiz 85-6.
Wetter DA, Camilleri MJ. Clinical, etiologic, and histopathologic features of Stevens-Johnson syndrome during an 8-year period at Mayo Clinic. Mayo Clin Proc. 2010;85(2):131–8.
Ferrandiz-Pulido C, Garcia-Patos V. A review of causes of Stevens-Johnson syndrome and toxic epidermal necrolysis in children. Arch Dis Child. 2013;98(12):998–1003.
Sassolas B, Haddad C, Mockenhaupt M, Dunant A, Liss Y, Bork K, et al. ALDEN, an algorithm for assessment of drug causality in Stevens-Johnson syndrome and toxic epidermal necrolysis: comparison with case-control analysis. Clin Pharmacol Ther. 2010;88(1):60–8.
Sekula P, Dunant A, Mockenhaupt M, Naldi L, Bouwes Bavinck JN, Halevy S, et al. Comprehensive survival analysis of a cohort of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. J Invest Dermatol. 2013;133(5):1197–204.
Dorafshar AH, Dickie SR, Cohn AB, Aycock JK, O'Connor A, Tung A, et al. Antishear therapy for toxic epidermal necrolysis: an alternative treatment approach. Plast Reconstr Surg. 2008;122(1):154–60.
Boorboor P, Vogt PM, Bechara FG, Alkandari Q, Aust M, Gohritz A, et al. Toxic epidermal necrolysis: use of Biobrane or skin coverage reduces pain, improves mobilisation and decreases infection in elderly patients. Burns. 2008;34(4):487–92.
Roujeau JC, Stern RS. Severe adverse cutaneous reactions to drugs. N Engl J Med. 1994;331(19):1272–85.
Duong TA, Valeyrie-Allanore L, Wolkenstein P, Chosidow O. Severe cutaneous adverse reactions to drugs. Lancet (London, England). 2017;390(10106):1996–2011.
Schwartz RA, McDonough PH, Lee BW. Toxic epidermal necrolysis: Part II. Prognosis, sequelae, diagnosis, differential diagnosis, prevention, and treatment. J Am Acad Dermatol. 2013;69(2):187.e1–16 quiz 203-4.
de Prost N, Mekontso-Dessap A, Valeyrie-Allanore L, Van Nhieu JT, Duong TA, Chosidow O, et al. Acute respiratory failure in patients with toxic epidermal necrolysis: clinical features and factors associated with mechanical ventilation. Crit Care Med. 2014;42(1):118–28.
Heng YK, Lee HY, Roujeau JC. Epidermal necrolysis: 60 years of errors and advances. Br J Dermatol. 2015;173(5):1250–4.
Roujeau JC, Bricard G, Nicolas JF. Drug-induced epidermal necrolysis: important new piece to end the puzzle. J Allergy Clin Immunol. 2011;128(6):1277–8.
Ko TM, Chung WH, Wei CY, Shih HY, Chen JK, Lin CH, et al. Shared and restricted T-cell receptor use is crucial for carbamazepine-induced Stevens-Johnson syndrome. J Allergy Clin Immunol. 2011;128(6):1266–76.e11.
Nassif A, Bensussan A, Boumsell L, Deniaud A, Moslehi H, Wolkenstein P, et al. Toxic epidermal necrolysis: effector cells are drug-specific cytotoxic T cells. J Allergy Clin Immunol. 2004;114(5):1209–15.
Morel E, Escamochero S, Cabanas R, Diaz R, Fiandor A, Bellon T. CD94/NKG2C is a killer effector molecule in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. J Allergy Clin Immunol. 2010;125(3):703–10 10.e1–10.e8.
Tohyama M, Hashimoto K. Immunological mechanisms of epidermal damage in toxic epidermal necrolysis. Curr Opin Allergy Clin Immunol. 2012;12(4):376–82.
Paul C, Wolkenstein P, Adle H, Wechsler J, Garchon HJ, Revuz J, et al. Apoptosis as a mechanism of keratinocyte death in toxic epidermal necrolysis. Br J Dermatol. 1996;134(4):710–4.
Chung WH, Hung SI, Yang JY, Su SC, Huang SP, Wei CY, et al. Granulysin is a key mediator for disseminated keratinocyte death in Stevens-Johnson syndrome and toxic epidermal necrolysis. Nat Med. 2008;14(12):1343–50.
Abe R, Yoshioka N, Murata J, Fujita Y, Shimizu H. Granulysin as a marker for early diagnosis of the Stevens-Johnson syndrome. Ann Intern Med. 2009;151(7):514–5.
Nassif A, Moslehi H, Le Gouvello S, Bagot M, Lyonnet L, Michel L, et al. Evaluation of the potential role of cytokines in toxic epidermal necrolysis. J Invest Dermatol. 2004;123(5):850–5.
de Araujo E, Dessirier V, Lapree G, Valeyrie-Allanore L, Ortonne N, Stathopoulos EN, et al. Death ligand TRAIL, secreted by CD1a+ and CD14+ cells in blister fluids, is involved in killing keratinocytes in toxic epidermal necrolysis. Exp Dermatol. 2011;20(2):107–12.
Mor G, Straszewski S, Kamsteeg M. The Fas/FasL system in reproduction: survival and apoptosis. TheScientificWorldJournal. 2002;2:1828–42.
White KD, Abe R, Ardern-Jones M, Beachkofsky T, Bouchard C, Carleton B, et al. SJS/TEN 2017: building multidisciplinary networks to drive science and translation. J Allergy Clin Immunol Pract. 2018;6(1):38–69.
Bruschi M, Petretto A, Vaglio A, Santucci L, Candiano G, Ghiggeri GM. Annexin A1 and autoimmunity: from basic science to clinical applications. Int J Mol Sci. 2018;19(5).
Saito N, Qiao H, Yanagi T, Shinkuma S, Nishimura K, Suto A, et al. An annexin A1-FPR1 interaction contributes to necroptosis of keratinocytes in severe cutaneous adverse drug reactions. Sci Transl Med. 2014;6(245):245ra95.
• Micheletti RG, Chiesa-Fuxench Z, Noe MH, Stephen S, Aleshin M, Agarwal A, et al. Stevens-Johnson syndrome/toxic epidermal necrolysis: a multicenter retrospective study of 377 adult patients from the United States. J Invest Dermatol. 2018;138(11):2315–21 Largest cohort of US SJS/TEN patients. Presents valuable epidemiologic data, such as mortality rates and different treatment approaches in 18 US academic medical centers.
Roujeau JC. Treatment of severe drug eruptions. J Dermatol. 1999;26(11):718–22.
Campione E, Marulli GC, Carrozzo AM, Chimenti MS, Costanzo A, Bianchi L. High-dose intravenous immunoglobulin for severe drug reactions: efficacy in toxic epidermal necrolysis. Acta Derm Venereol. 2003;83(6):430–2.
Chen J, Wang B, Zeng Y, Xu H. High-dose intravenous immunoglobulins in the treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis in Chinese patients: a retrospective study of 82 cases. Eur J Dermatol. 2010;20(6):743–7.
Kim KJ, Lee DP, Suh HS, Lee MW, Choi JH, Moon KC, et al. Toxic epidermal necrolysis: analysis of clinical course and SCORTEN-based comparison of mortality rate and treatment modalities in Korean patients. Acta Derm Venereol. 2005;85(6):497–502.
Stella M, Clemente A, Bollero D, Risso D, Dalmasso P. Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS): experience with high-dose intravenous immunoglobulins and topical conservative approach. A retrospective analysis. Burns. 2007;33(4):452–9.
Trent JT, Kirsner RS, Romanelli P, Kerdel FA. Analysis of intravenous immunoglobulin for the treatment of toxic epidermal necrolysis using SCORTEN: the University of Miami experience. Arch Dermatol. 2003;139(1):39–43.
Rajaratnam R, Mann C, Balasubramaniam P, Marsden JR, Taibjee SM, Shah F, et al. Toxic epidermal necrolysis: retrospective analysis of 21 consecutive cases managed at a tertiary centre. Clin Exp Dermatol. 2010;35(8):853–62.
Bastuji-Garin S, Fouchard N, Bertocchi M, Roujeau JC, Revuz J, Wolkenstein P. SCORTEN: a severity-of-illness score for toxic epidermal necrolysis. J Invest Dermatol. 2000;115(2):149–53.
Cartotto R, Mayich M, Nickerson D, Gomez M. SCORTEN accurately predicts mortality among toxic epidermal necrolysis patients treated in a burn center. J Burn Care Res. 2008;29(1):141–6.
Bachot N, Revuz J, Roujeau JC. Intravenous immunoglobulin treatment for Stevens-Johnson syndrome and toxic epidermal necrolysis: a prospective noncomparative study showing no benefit on mortality or progression. Arch Dermatol. 2003;139(1):33–6.
Halebian PH, Corder VJ, Madden MR, Finklestein JL, Shires GT. Improved burn center survival of patients with toxic epidermal necrolysis managed without corticosteroids. Ann Surg. 1986;204(5):503–12.
Law EH, Leung M. Corticosteroids in Stevens-Johnson syndrome/toxic epidermal necrolysis: current evidence and implications for future research. Ann Pharmacother. 2015;49(3):335–42.
Schneck J, Fagot JP, Sekula P, Sassolas B, Roujeau JC, Mockenhaupt M. Effects of treatments on the mortality of Stevens-Johnson syndrome and toxic epidermal necrolysis: a retrospective study on patients included in the prospective EuroSCAR Study. J Am Acad Dermatol. 2008;58(1):33–40.
•• Wang CW, Yang LY, Chen CB, Ho HC, Hung SI, Yang CH, et al. Randomized, controlled trial of TNF-alpha antagonist in CTL-mediated severe cutaneous adverse reactions. J Clin Invest. 2018;128(3):985–96 Features as one of the few randomized controlled trials in SJS/TEN. Reveals the superiority, in terms of mortality rate reduction, of etanercept compared to systemic corticosteroids.
Valeyrie-Allanore L, Wolkenstein P, Brochard L, Ortonne N, Maitre B, Revuz J, et al. Open trial of ciclosporin treatment for Stevens-Johnson syndrome and toxic epidermal necrolysis. Br J Dermatol. 2010;163(4):847–53.
Kirchhof MG, Miliszewski MA, Sikora S, Papp A, Dutz JP. Retrospective review of Stevens-Johnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine. J Am Acad Dermatol. 2014;71(5):941–7.
• Gonzalez-Herrada C, Rodriguez-Martin S, Cachafeiro L, Lerma V, Gonzalez O, Lorente JA, et al. Cyclosporine use in epidermal necrolysis is associated with an important mortality reduction: evidence from three different approaches. J Invest Dermatol. 2017;137(10):2092–100 Clinical trial of cyclosporine compared to other therapies including IVIG and systemic steroids for the treatment of SJS/TEN. Although not a randomized study, this trial presents significant evidence supporting better mortality outcomes with the use of cyclosporine.
• Papp A, Sikora S, Evans M, Song D, Kirchhof M, Miliszewski M, et al. Treatment of toxic epidermal necrolysis by a multidisciplinary team. A review of literature and treatment results. Burns. 2018;44(4):807–15 Cohort of 67 single-center patients from a Hospital in Canada. Provides quantitative data on SJS/TEN triggers, length of stay, wound dressings, complications, and mortality. Helpful educational tool for healthcare providers.
Endorf FW, Cancio LC, Gibran NS. Toxic epidermal necrolysis clinical guidelines. J Burn Care Res. 2008;29(5):706–12.
Richard EB, Hamer D, Musso MW, Short T, O'Neal HR Jr. Variability in management of patients with SJS/TEN: a survey of burn unit directors. J Burn Care Res. 2018;39(4):585–92.
Ying S, Ho W, Chan HH. Toxic epidermal necrolysis: 10 years experience of a burns Centre in Hong Kong. Burns. 2001;27(4):372–5.
Atiyeh BS, Dham R, Yassin MF, El-Musa KA. Treatment of toxic epidermal necrolysis with moisture-retentive ointment: a case report and review of the literature. Dermatol Surg. 2003;29(2):185–8.
Castillo B, Vera N, Ortega-Loayza AG, Seminario-Vidal L. Wound care for Stevens-Johnson syndrome and toxic epidermal necrolysis. J Am Acad Dermatol. 2018;79(4):764–7.e1.
•• Nizamoglu M, Ward JA, Frew Q, Gerrish H, Martin N, Shaw A, et al. Improving mortality outcomes of Stevens Johnson syndrome/toxic epidermal necrolysis: a regional burns centre experience. Burns. 2018;44(3):603–11 Retrospective review of SJS/TEN patients in a burns center in the UK. Provides an in-depth analysis of the debridement alternatives and their role in the management of SJS/TEN patients. Also, presents a literature review of wound dressings and grafts.
•• McPherson T, Exton LS, Biswas S, Creamer D, Dziewulski P, Newell L, et al. British Association of Dermatologists’ guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in children and young people, 2018. Br J Dermatol. 2019;181(1):37–54 British dermatologic guidelines for the management of SJS/TEN in children. Extremely detailed, step-by-step guidline for an integral treatment regimen. Provides clear recommendations for surgical vs. non-surgical approaches and suggestions for wound dressing selection.
•• Creamer D, Walsh SA, Dziewulski P, Exton LS, Lee HY, Dart JK, et al. U.K. guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016. Br J Dermatol. 2016;174(6):1194–227 British dermatologic guidelines for the management of SJS/TEN in Adults. Extremely detailed, step-by-step guidline for an integral treatment regimen. Provides clear recommendations for surgical vs. non-surgical approaches and suggestions for wound dressing selection. Also, displays a convenient treatment algorith with the diffents strengths of recommendation.
Creamer D, Walsh SA, Dziewulski P, Exton LS, Lee HY, Dart JKG, et al. UK guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016. J Plast Reconstr Aesthet Surg. 2016;69(6):e119–e53.
• Abela C, Hartmann CE, De Leo A, de Sica Chapman A, Shah H, Jawad M, et al. Toxic epidermal necrolysis (TEN): the Chelsea and Westminster Hospital wound management algorithm. J Plast Reconstr Aesthet Surg. 2014;67(8):1026–32 Presents the treatment experience of a burns center in the UK. Provides a pragmatic wound management algorithm, including sequential severity stages and their respective treatment recommendaiton. The role of debridement, emollients, antimicrobial dressings, and skin grafts is precisely discussed.
Evans J. Topical treatment protocol for Stevens-Johnson syndrome and toxic epidermal necrolysis: a brief report. J Wound Ostomy Continence Nurs. 2009;36(5):509–11.
Castillo B, Vera N, Ortega-Loayza AG, Seminario-Vidal L. Wound care for Stevens-Johnson syndrome and toxic epidermal necrolysis. J Am Acad Dermatol. 2018;79(4):764–7.e1
• Ingen-Housz-Oro S, Duong TA, Bensaid B, Bellon N, de Prost N, Lu D, et al. Epidermal necrolysis French national diagnosis and care protocol (PNDS; protocole national de diagnostic et de soins). Orphanet J Rare Dis. 2018;13(1):56 Guideline and recommendations from the French National Reference Center for Toxic Bullous Dermatosis for the diagnosis and management of epidemal necrolysis. Proposes a non-surgical management, recommending the non-removal of the detached epidermis.
Mahar PD, Wasiak J, Hii B, Cleland H, Watters DA, Gin D, et al. A systematic review of the management and outcome of toxic epidermal necrolysis treated in burns centres. Burns. 2014;40(7):1245–54.
Le HG, Saeed H, Mantagos IS, Mitchell CM, Goverman J, Chodosh J. Burn unit care of Stevens Johnson syndrome/toxic epidermal necrolysis: a survey. Burns. 2016;42(4):830–5.
Dodiuk-Gad RP, Olteanu C, Jeschke MG, Cartotto R, Fish J, Shear NH. Treatment of toxic epidermal necrolysis in North America. J Am Acad Dermatol. 2015;73(5):876–7.e2.
Cartotto R. Burn Center Care of Patients with Stevens-Johnson syndrome and toxic epidermal Necrolysis. Clin Plast Surg. 2017;44(3):583–95.
Dreyfuss DA, Gottlieb LJ, Wilkerson DK, Parsons RW, Krizek TJ. Survival after a second episode of toxic epidermal necrolysis. Ann Plast Surg. 1988;20(2):146–7.
Imahara SD, Holmes JH, Heimbach DM, Engrav LE, Honari S, Klein MB, et al. SCORTEN overestimates mortality in the setting of a standardized treatment protocol. J Burn Care Res. 2006;27(3):270–5.
•• McCullough M, Burg M, Lin E, Peng D, Garner W. Steven Johnson Syndrome and Toxic Epidermal Necrolysis in a burn unit: a 15-year experience. Burns. 2017;43(1):200–5 SJS/TEN management experience of an academic center in California. Provides a comprehensive treatment algorithm for SJS/TEN. Proposes debridement of devitalized epidermis and discusses the use of protective dressings and topical therapy.
Lindford A, Vuola J. Re: toxic epidermal necrolysis (TEN): the Chelsea and Westminster hospital wound management algorithm. J Plast Reconstr Aesthet Surg. 2015;68(2):288–9.
Lindford AJ, Kaartinen IS, Virolainen S, Vuola J. Comparison of Suprathel(R) and allograft skin in the treatment of a severe case of toxic epidermal necrolysis. Burns. 2011;37(7):e67–72.
Kakagia DD, Karadimas EJ. The efficacy of Versajet hydrosurgery system in burn surgery. A systematic review. J Burn Care Res. 2018;39(2):188–200.
Ferrer-Sola M, Sureda-Vidal H, Altimiras-Roset J, Fontsere-Candell E, Gonzalez-Martinez V, Espaulella-Panicot J, et al. Hydrosurgery as a safe and efficient debridement method in a clinical wound unit. J Wound Care. 2017;26(10):593–9.
Legemate CM, Goei H, Gostelie OFE, Nijhuis THJ, van Baar ME, van der Vlies CH. Application of hydrosurgery for burn wound debridement: an 8-year cohort analysis. Burns. 2019;45(1):88–96.
Edwards K, Stokes H, Suttle K, Potts C, Coles K. Topical treatment protocol for Stevens-Johnson syndrome and toxic epidermal necrolysis. J Wound Ostomy Continence Nurs. 2009;36(3):330–4.
Rogers AD, Blackport E, Cartotto R. The use of Biobrane((R)) for wound coverage in Stevens-Johnson syndrome and toxic epidermal necrolysis. Burns. 2017;43(7):1464–72.
Asz J, Asz D, Moushey R, Seigel J, Mallory SB, Foglia RP. Treatment of toxic epidermal necrolysis in a pediatric patient with a nanocrystalline silver dressing. J Pediatr Surg. 2006;41(12):e9–12.
Khundkar R, Malic C, Burge T. Use of Acticoat dressings in burns: what is the evidence? Burns. 2010;36(6):751–8.
Palmieri TL, Greenhalgh DG, Saffle JR, Spence RJ, Peck MD, Jeng JC, et al. A multicenter review of toxic epidermal necrolysis treated in U.S. burn centers at the end of the twentieth century. J Burn Care Rehabil. 2002;23(2):87–96.
Tredget EE, Shankowsky HA, Groeneveld A, Burrell R. A matched-pair, randomized study evaluating the efficacy and safety of Acticoat silver-coated dressing for the treatment of burn wounds. J Burn Care Rehabil. 1998;19(6):531–7.
Smith SD, Dodds A, Dixit S, Cooper A. Role of nanocrystalline silver dressings in the management of toxic epidermal necrolysis (TEN) and TEN/Stevens-Johnson syndrome overlap. Australas J Dermatol. 2015;56(4):298–302.
Zou SB, Yoon WY, Han SK, Jeong SH, Cui ZJ, Kim WK. Cytotoxicity of silver dressings on diabetic fibroblasts. Int Wound J. 2013;10(3):306–12.
Choi H, Castillo B, Seminario-Vidal L. Silver absorption in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis treated with silver-impregnated dressings. A case series. Int Wound J. 2018;15(6):1049–51.
Varas RP, O'Keeffe T, Namias N, Pizano LR, Quintana OD, Herrero Tellachea M, et al. A prospective, randomized trial of Acticoat versus silver sulfadiazine in the treatment of partial-thickness burns: which method is less painful? J Burn Care Rehabil. 2005;26(4):344–7.
Yin HQ, Langford R, Burrell RE. Comparative evaluation of the antimicrobial activity of ACTICOAT antimicrobial barrier dressing. J Burn Care Rehabil. 1999;20(3):195–200.
Mosti G, Magliaro A, Mattaliano V, Picerni P, Angelotti N. Comparative study of two antimicrobial dressings in infected leg ulcers: a pilot study. J Wound Care. 2015;24(3):121–2 4-7.
Gentili V, Gianesini S, Balboni PG, Menegatti E, Rotola A, Zuolo M, et al. Panbacterial real-time PCR to evaluate bacterial burden in chronic wounds treated with Cutimed Sorbact. Eur J Clin Microbiol Infect Dis. 2012;31(7):1523–9.
Borkow G, Gabbay J, Dardik R, Eidelman AI, Lavie Y, Grunfeld Y, et al. Molecular mechanisms of enhanced wound healing by copper oxide-impregnated dressings. Wound Repair Regen. 2010;18(2):266–75.
Tenaud I, Sainte-Marie I, Jumbou O, Litoux P, Dreno B. In vitro modulation of keratinocyte wound healing integrins by zinc, copper and manganese. Br J Dermatol. 1999;140(1):26–34.
Kirsner RS, Amaya R, Bass K, Boyar V, Ciprandi G, Glat PM, et al. Effects of a surfactant-based gel on acute and chronic paediatric wounds: a panel discussion and case series. J Wound Care. 2019;28(6):398–408.
Salisbury AM, Percival SL. Efficacy of a surfactant-based wound dressing in the prevention of biofilms. Adv Skin Wound Care. 2018;31(11):514–20.
• Young JB, Gondek SP, Troche M, Summitt JB, Rae L, Thayer WP, et al. The use of porcine xenografts in patients with toxic epidermal necrolysis. Burns. 2016;42(8):1728–33 Retrospective review of use of porcine xenografts in SJS/TEN patients. Presents evidence of wound pain reduction after the application of the porcine xenograft. Evaluates the utility of these advance dressings and recommend their placement in patiens with >20% of involved body surface area.
Alavi A, Kirsner R. Dressings. In: Bolognia J, Schaffer JV, Cerroni L, editors. Dermatology (Basel, Switzerland). 4th ed: Elsevier Limited; 2018. p. 2462–77.
Heimbach DM, Engrav LH, Marvin JA, Harnar TJ, Grube BJ. Toxic epidermal necrolysis. A step forward in treatment. Jama. 1987;257(16):2171–5.
Birchall N, Langdon R, Cuono C, McGuire J. Toxic epidermal necrolysis: an approach to management using cryopreserved allograft skin. J Am Acad Dermatol. 1987;16(2 Pt 1):368–72.
Pianigiani E, Ierardi F, Taddeucci P, Perotti R, Biagioli M, Di Simplicio FC, et al. Skin allograft in the treatment of toxic epidermal necrolysis (TEN). Dermatol Surg. 2002;28(12):1173–6.
Bradley T, Brown RE, Kucan JO, Smoot EC 3rd, Hussmann J. Toxic epidermal necrolysis: a review and report of the successful use of Biobrane for early wound coverage. Ann Plast Surg. 1995;35(2):124–32.
Arevalo JM, Lorente JA. Skin coverage with Biobrane biomaterial for the treatment of patients with toxic epidermal necrolysis. J Burn Care Rehabil. 1999;20(5):406–10.
Bannasch H, Kontny U, Kruger M, Stark GB, Niemeyer CM, Brandis M, et al. A semisynthetic bilaminar skin substitute used to treat pediatric full-body toxic epidermal necrolysis: wraparound technique in a 17-month-old girl. Arch Dermatol. 2004;140(2):160–2.
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Jaller, J.A., McLellan, B.N. & Balagula, Y. Wound Management in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Curr Derm Rep 9, 58–72 (2020). https://doi.org/10.1007/s13671-020-00285-3
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DOI: https://doi.org/10.1007/s13671-020-00285-3