gms | German Medical Science

29. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2011)

12.01. - 15.01.2011, Grindelwald, Schweiz

Toxic epidermal necrolysis – mucosal involvement and total body surface area affects mortality

Meeting Abstract

  • R. Ipaktchi - Klinik für Plastische und Wiederherstellungschirurgie, Inselspital Bern, Bern
  • K. Knobloch - Klinik für Plastische und Wiederherstellungschirurgie, Inselspital Bern, Bern
  • H. O. Rennekampff - Klinik für Plastische und Wiederherstellungschirurgie, Inselspital Bern, Bern
  • A. Banic - Klinik für Plastische und Wiederherstellungschirurgie, Inselspital Bern, Bern
  • P. M. Vogt - Klinik für Plastische und Wiederherstellungschirurgie, Inselspital Bern, Bern

DAV 2011. 29. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung. Grindelwald, Schweiz, 12.-15.01.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dav19

DOI: 10.3205/11dav19, URN: urn:nbn:de:0183-11dav192

Published: June 21, 2011

© 2011 Ipaktchi et al.
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Outline

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Background: Toxic epidermal necrolysis (TEN) is a rare drug-induced and potential life-threatening acute condition with an incidence of 1–2 per million. Commonly it is associated with a history of exposure to antibiotics such as cotrimoxacol, allopurinol or anticonvulsants. A clinical criterion for TEN is epidermal necrosis and detachment of more than 30% TBSA. Some cases of TEN involve mucosa as well. Because of the extensive skin detachment, water and protein loss, burn units are an appropriate unit for the treatment of TEN. The treatment is supportive and the administration of steroids and other immuno-suppressive drugs is discussed controversially. Recent data suggest that early administration of immunoglobuline during the first 4 days might be beneficial in this regard. Nevertheless, the mortality varies between 25–50% and can be predicted by the SCORTEN Score. It consists of seven different risk factors (age, tachycardia, hyperglycemia, malignancy, epidermolysis >10% TBSA, elevated BUN and decreased serum bicarbonate) and each risk factor receives a score of 1.

Methods: Retrospective single center clinical observation study. Outcome measure: Death. Inclusion criteria: histological confirmed TEN > than 30% TBSA. Statistical analysis: Chi-Square-Test.

Results: From 2003–2009 a total number of 25 patients (11 male, 14 female) with a mean TBSA of 56±26% were treated for toxic epidermal necrolysis at a burn unit in Hannover Medical School, Germany. All patients were treated according to a standardized treatment protocol. Mean age was 68±20 years. Complications included sepsis, multidrug-resistant wound infections, HIT 2, pneumonia, myocardial infarction, lung embolism, acute renal failure, colitis, arterial embolism. Overall, ten out of 25 patients died resulting in a 40% mortality rate. Mucosal affection was seen in 16 out of 25 patients. Among the patients surviving, mean age was 67±20 years, mean TBSA 46±20% and mucosal affects was present in 47%. Nine out of ten (90%) of the dead patients showed mucosal affections (p=0,027) with a mean age of 70±23 years and a mean TBSA of 71±27% (p=0,01).

Conclusions: Our study suggests that mucosal affection and TBSA >50% are associated with increased mortality in our patients. Our results prompted us to propose at best a prospective multicenter study evaluating the role of mucosal affection in toxic epidermal necrolysis. Mucosal affection and TBSA >50% in TEN appear to have an association with increased mortality rate in TEN.