Treatment

Standard of care

After the patient has been diagnosed, the potential/suspect medication responsible for toxic epidermal necrolysis (TEN) should be discontinued immediately. This should be quickly followed with a transfer to a burn intensive care unit.

Medications

Several case reports and non-controlled small-sample studies have observed positive responses with cyclosporine, cyclophosphamide, N-acetylcysteine (asthma, bronchitis, mercury poison treatment and chemotherapy and radiation side effect prevention) and plasmapheresis (blood purification technique) in TEN patients (11-16). Intravenous Immunoglobulin (IVIG) (blood product) has been considered in the treatment of TEN (19, 21, 23-30). Four formulations of IVIG are currently available in Canada. Studies thus far have not reported any major adverse effects with IVIG use in TEN patients (17-32). Corticosteroids, on the other hand, have remained controversial with some studies recommending its use (33-45) while others consider it detrimental (15,16,46-54).

Hospital care

Supportive care, monitoring of vital functions and local management of denuded skin should be implemented in order to avoid fluid and protein losses as well as wound infections.

Recovery process

TEN specifically is associated with a slow recovery process (three to six weeks). Late complications can include ocular involvement, skin and nail pigment changes, vulvovaginal synechiae and vaginal stenosis (55).

* IVIG is not licensed for Stevens Johnson Syndrome or Toxic Epidermal Necrolysis indications.
* Research is currently underway.