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Pediatric Toxic Epidermal Necrolysis: Experience of a Tertiary Burn Center
Author(s) -
Rizzo Julie A.,
Johnson Rebekah,
Cartie Richard J.
Publication year - 2015
Publication title -
pediatric dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 73
eISSN - 1525-1470
pISSN - 0736-8046
DOI - 10.1111/pde.12657
Subject(s) - toxic epidermal necrolysis , medicine , intensive care medicine , etiology , disease , specialty , total body surface area , medical prescription , retrospective cohort study , population , pediatrics , dermatology , surgery , pathology , environmental health , pharmacology
Background Pediatric toxic epidermal necrolysis ( TEN ) is a rare and potentially fatal skin disease with a multitude of causative factors and no consensus on treatment guidelines and, as a result, it has a variety of short‐ and long‐term outcomes. We present the experience of a large specialty burn center to share our diagnostic and treatment principles. Methods A retrospective review from 1989 to 2010 at the Joseph M. Still Burn Center was performed to find patients with a diagnosis of Steven–Johnson syndrome ( SJS ) or TEN . Information was obtained on demographic and physiologic parameters such as age, race, total body surface area involved, treatments, hospital stay, and need for ventilator support. Results We identified SJS or TEN in 21 patients. Prescription drugs were the most common etiology (in 15 patients), with antibiotics as the most common causative agent. Histology confirmed the clinical diagnosis of TEN in 14 patients. Our treatment plan included a multidisciplinary team, early initiation of intravenous immunoglobulin, bronchoscopy, strict management of electrolyte and fluid balances, and meticulous surgical wound care. Mortality was 9.5%. Conclusion Our experience in treating this rare but devastating disease affords us the opportunity to share the diagnostic dilemmas we faced and the treatment principles we used to treat this unique patient population successfully.