gms | German Medical Science

Introduction: Toxic epidermal necrolysis (TEN) is a rare dermatologic disease that is part of a spectrum of drug related exfoliative disorders including Steven-Johnson syndrome (SJS) and SJS/TEN overlap. These are characterized by a variable degree of epidermal detachment at the dermoepidermal junction, resulting in microscopic changes comparable with those that occur in superficial dermal burns, justifying the need for patient management in a specialized burn unit. The main objective of this study was to determine the time required for the wounds to heal and the infection rates when using Biobrane for skin coverage.

Material and methods: A retrospective chart review of drug related exfoliative disorders including TEN and SJS/TEN overlap from January 1999 to December 2007 was performed. The parameters included in the study were patient demographics, time from disease onset to burn unit admission, total surface area of detached skin and/or mucosal involvement, the area and anatomy covered with Biobrane, healing time, complications, mortality and outcome.

Results: A total of thirty-two patients were identified with either TEN or SJS/TEN overlap, nineteen were female and thirteen were male. The patients studied had a mean age of 55.7 ± 21.1 years (range, 18 to 86 years). Time from initial onset of symptoms to burn unit admission was 7.2 ± 3.36 days (range, 3 to 18 days), body surface area of epidermal detachment was 41% ± 23% (range, 10% to 100%). Twenty-eight patients (87.5%) required wound coverage with Biobrane, the mean surface area covered was 39.2% ± 20.9% (range, 10% to 90%), time from admission to complete reepithelialization in the surviving patients was 10 ± 3.9 days (range 5 to 20 days). Only 4 patients (14.3%) developed a wound infection, and only two of those required complete removal of Biobrane.

Conclusion: In this susceptible group of patients, skin coverage with a synthetic skin substitute such as Biobrane early in the course of treatment provides barrier protection, helping to reduce wound infection rates and promote rapid healing.