Document Detail


Basic measures and systemic medical treatment of patients with toxic epidermal necrolysis.
MedLine Citation:
PMID:  19845819     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: With an incidence of 1.5-1.8/1 million inhabitants per year, toxic epidermal necrolysis is a rare but life threatening disease. It is almost always drug-induced and its lethality is pronounced with up to 50 %. Several therapeutic options are described in literature; however, there is still lack of a universally accepted and specific therapy of toxic epidermal necrolysis. METHODS: This survey considers 8 cases of toxic epidermal necrolysis diagnosed and treated in our clinic from 2003 to 2007. The epidermal sloughing was > 30 % of the body surface in each case. RESULTS: After immediately discontinuing the drug suspected of being responsible for toxic epidermal necrolysis, we treated with systemic corticosteroids in an initial dose of up to 1.5 mg/kg. Moreover, special emphasis was put on basic measures such as control of vital parameters. With this treatment we reached good results; none of the patients died. conclusions: Immediate beginning of therapy is essential for a successful treatment of toxic epidermal necrolysis. Besides systemic therapy with corticosteroids, certain basic measures such as isolation of patients at adequate room temperature to prevent hypothermia, strict control of circulation, temperature and laboratory parameters, daily smears of skin and mucous membranes and a diet rich in calories due to the catabolic metabolic status are very important for successful outcome.
Authors:
Imke Hanken; Melanie Schimmer; Christian A Sander
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-10-21
Journal Detail:
Title:  Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG     Volume:  8     ISSN:  1610-0387     ISO Abbreviation:  J Dtsch Dermatol Ges     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-06-11     Completed Date:  2010-11-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101164708     Medline TA:  J Dtsch Dermatol Ges     Country:  Germany    
Other Details:
Languages:  eng; ger     Pagination:  341-6     Citation Subset:  IM    
Affiliation:
Eduard Arning Clinic for Dermatology and Allergology, Asklepios Clinic St. Georg, Hamburg, Germany. i.hanken@asklepios.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Allopurinol / therapeutic use,  toxicity
Anti-Bacterial Agents / therapeutic use,  toxicity
Anti-Inflammatory Agents / therapeutic use
Anticonvulsants / therapeutic use,  toxicity
Bacterial Infections / diagnosis,  drug therapy,  mortality
Ciprofloxacin / therapeutic use,  toxicity
Drug Combinations
Epidermal Necrolysis, Toxic / diagnosis,  drug therapy*,  mortality
Female
Folic Acid / therapeutic use,  toxicity
Gout Suppressants / therapeutic use,  toxicity
Humans
Hydroxocobalamin / therapeutic use,  toxicity
Lidocaine / therapeutic use,  toxicity
Male
Middle Aged
Phenytoin / therapeutic use,  toxicity
Prednisone / therapeutic use*
Pyridoxine / therapeutic use,  toxicity
Superinfection / diagnosis,  drug therapy,  mortality
Survival Rate
Trimethoprim-Sulfamethoxazole Combination / therapeutic use,  toxicity
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Anti-Inflammatory Agents; 0/Anticonvulsants; 0/Drug Combinations; 0/Gout Suppressants; 13422-51-0/Hydroxocobalamin; 137-58-6/Lidocaine; 315-30-0/Allopurinol; 53-03-2/Prednisone; 57-41-0/Phenytoin; 59-30-3/Folic Acid; 65-23-6/Pyridoxine; 8064-90-2/Trimethoprim-Sulfamethoxazole Combination; 85721-33-1/Ciprofloxacin
Comments/Corrections
Comment In:
J Dtsch Dermatol Ges. 2010 Sep;8(9):729-30; author reply 730   [PMID:  20821833 ]
J Dtsch Dermatol Ges. 2010 May;8(5):319-20   [PMID:  20536999 ]
J Dtsch Dermatol Ges. 2010 Sep;8(9):728-9; author reply 730   [PMID:  20821832 ]

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