S.D. Smith , A. Dodds , S. Dixit , A. Cooper
Introduction: Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome are severe mucocutaneous adverse drug reactions causing widespread keratinocyte apoptosis. Immune therapies which target the underlying disease process have been used to manage TEN, including intravenous immunoglobulin (IVIg), cyclosporine and corticosteroids, however, some controversy exists about the role of these medications. Current best management is through early recognition and cessation of the causative drug with the patient ideally being treated in a burns intensive care unit. Advances in dressing materials have resulted in non-adherent nanocrystalline silver containing gauzes being increasingly commonly used because of their broad antimicrobial effects. 4 We question if it is the antibac- terial effect of silver alone, or is it the possible antiinﬂammatory effects that beneﬁt TEN patients.
Method: A retrospective case review of patients admitted to
Royal North Shore Hospital between 2011–2013 with the
diagnosed with SJS/TEN crossover or TEN was performed.
Results: Nine patients with a mean age of 63.5 years (range
23 to 95) were included in this case series. The majority of
patients were female (77%). In all patients, the causative
medication was identiﬁed and ceased as soon as possible.
SCORTEN varied between 0 and 5 and the total body surface
area percentage ranged from 10% to 98%. Intravenous
immunoglobulin was administered to patients with a BSA
involvement >30%. Seven of the nine patients were also
administered systemic steroids and half were commenced
on systemic antimicrobials. Nanocrystalline silver impregnated
gauze dressings (Acticoat™) were used in all patients.