Management of toxic epidermal necrolysis in a pediatric burn center
N. S. Adzick, S. H. Kim, C. C. Bondoc, W. C. Quinby and J. P. Remensnyder
Toxic epidermal necrolysis (TEN) is an acute severe exfoliative skin and
mucosal membrane disorder with a clinical picture similar to a total-body
scald injury. Toxic epidermal necrolysis shares features with severe
erythema multiforme seen in Stevens-Johnson syndrome, and is thought by
some to be a maximal expression of this syndrome. Drug-related TEN is
uncommon in children. Mortalities of 70% have been reported, and death is
usually secondary to the bacterial and metabolic consequences of a large
open wound. Over the past two years, four children with probable
drug-induced TEN were treated successfully. Since the problems of
infection, wound care, fluid balance, nutrition, and pain control are
similar in TEN and major burn patients, treatment using the principles of
burn care may improve survival.
