Toxic Epidermal Necrolysis and Steven–Johnson Syndrome: A Comprehensive Review

Autor: Kevin Phan, Christopher J. Jackson, Alan Cooper, Erin Mewton, Victoria Harris, Olivia Charlton
Rok vydání: 2020
Předmět:
0301 basic medicine
medicine.medical_specialty
Swine
Burn Units
Transplantation
Heterologous
Mucocutaneous zone
Prospective data
Holistic Health
Disease
Throat surgery
Critical Care and Intensive Care Medicine
Tertiary Care Centers
030207 dermatology & venereal diseases
03 medical and health sciences
Wound care
0302 clinical medicine
Adrenal Cortex Hormones
medicine
Animals
Humans
Immunologic Factors
Intensive care medicine
Nose
Skin
Patient Care Team
Comprehensive Invited Reviews
Wound Healing
Nutritional Support
business.industry
Palliative Care
Immunoglobulins
Intravenous
Skin Transplantation
Length of Stay
medicine.disease
Bandages
Toxic epidermal necrolysis
Colorectal surgery
Hospitalization
Treatment Outcome
030104 developmental biology
medicine.anatomical_structure
Stevens-Johnson Syndrome
Cyclosporine
Emergency Medicine
business
Zdroj: Adv Wound Care (New Rochelle)
ISSN: 2162-1934
2162-1918
Popis: Significance: Toxic epidermal necrolysis (TEN) and Steven–Johnson syndrome (SJS) are potentially fatal acute mucocutaneous vesiculobullous disorders. Evidence to date suggests that outcomes for patients with both TEN and SJS are largely dependent on stopping the causative agent, followed by supportive care and appropriate wound management in a specialized burns unit. These are life-threatening conditions characterized by widespread full-thickness cutaneous and mucosal necrosis. This article outlines the approach to holistic management of such patients, in a specialized unit, highlighting various practical aspects of wound care to prevent complications such as infection, mucosal and adhesions, and ocular scaring. Recent Advances: There is improved understanding of pain and morbidity with regard to the type and frequency of dressing changes. More modern dressings, such as nanocrystalline, are currently favored as they may be kept in situ for longer periods. The most recent evidence on systemic agents, such as corticosteroids and cyclosporine, and novel treatments, are also discussed. Critical Issues: Following cessation of the culprit trigger, management in a specialized burns unit is the most important management step. It is now understood that a multidisciplinary team is essential in the care of these patients. Following admission of such patients, dermatology, ear, nose, and throat surgery, ophthalmology, urology, colorectal surgery, and gynecology should all be consulted to prevent disease sequelae. Future Directions: Looking forward, research is aimed at achieving prospective data on the efficacy of systemic immunomodulating agents and dressing types. Tertiary centers with burns units should develop policies for such patients to ensure that the relevant teams are consulted promptly to avoid mucocutaneous complications.
Databáze: OpenAIRE
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