Management of toxic epidermal necrolysis

Toxic epidermal necrolysis and Stevens-Johnson syndrome are rare, life-threatening drug reactions. Widespread epidermal necrosis and mucosal erosions lead to complications similar to those developing after extensive burns. Treatment is supportive. The role of steroids and other potential disease-modifying agents remains to be established by controlled studies.     

外用汞制剂致中毒性表皮坏死松解症病例分析

牛皮癣外用汞制剂致中毒性表皮坏死松解症(TEN)合并汞中毒尚末见报道.我们救治1例牛皮癣外用汞制剂致TEN合并汞中毒的患者,临床表现复杂,症状严重,现分析报道如下.     

荒酸二甲酯致中毒性表皮坏死松解症病人的救治及护理

报道一例临床罕见的荒酸二甲酯中毒致全身表皮坏死松解症病人的救治过程，总结了护理方法。正确的创面处理，适时的知识宣教，恰当的心理疏导及必要的基础护理不仅促进了创面的愈合，更减少了感染等并发症的发生。     

Energy requirements of pediatric patients with Stevens-Johnson syndrome and toxic epidermal necrolysis

INTRODUCTION: The primary purpose of this study was to compare the measured resting energy requirements (MREE) of children with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) with that of children with burns of similar size. A secondary goal was to develop a predictive equation useful in estimating the energy of children with SJS/TEN. METHODS: This retrospective study included 30 patients admitted to our pediatric burn unit between 12/91 and 03/06. All patients were admitted within 10 days of injury and had at least 1 metabolic cart measurement. Fifteen patients with SJS/TEN comprised group 1. Group 2 consisted of 15 burn patients matched for total wound size, age, preinjury weight, and gender. Caloric intake and discharge weight (percent of preburn weight) were recorded. RESULTS: The energy needs of the SJS/TEN group were 22% less than the burn group. Correlation between MRE x 1.3 and caloric intake was 0.89 for the SJS/TEN group and 0.92 for the burn group (P < .0001). Both the SJS/TEN and burn groups were managed by nutrition goals based on the MREE x 1.3, and patients were 95.1% +/- 6.3% and 98.9% +/- 6% of preinjury weight at discharge, respectively, in each group. An equation for the estimation of energy requirements in pediatric SJS/TEN patients was statistically generated: (24.6 x weight in kg) + (% wound x 4.1) + 940. CONCLUSION: The energy requirement in pediatric SJS/TEN patients is less than that following burn injury. The application of a 30% factor to MREE is supported in SJS/TEN and thermal injury.     

Immune modulating nutrition support for a patient with severe toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) is a rare but serious condition with a high mortality rate, whose clinical features resemble major thermal injury. Nutritional substrates which can affect the immune response have been shown to benefit burned and critically ill patients but there is a lack of data in the TEN literature. A case study is presented of a 63-year-old female admitted to our burn unit with extensive skin and mucosal involvement. Immune modulating artificial nutrition support was given initially via the parenteral route and then the nasogastric route. Maintenance of the patient's nutritional status and clinical outcome suggest that there may be a role for this type of intervention in TEN.     

Nursing diagnoses for the patient with toxic epidermal necrolysis: a case study

This is a retrospective case study of a patient affected by toxic epidermal necrolysis in the intensive care unit of a public hospital, with the goal to apprehend, starting from the clinical judgments of the nurses, theirs nursing diagnoses. Thirteen nursing diagnoses were evidenced and, also, it was evidenced the necessity of the theoretical improvement of those professionals about the Systematization of Nursing Care, and on the sense of value that this practice may add to nursing in the pursuit of individualized assistance to the patients under their care.     

Toxic epidermal necrolysis.

Toxic epidermal necrolysis is a rapidly progressive dermatologic condition associated with high mortality. Several factors have been implicated in the development of toxic epidermal necrolysis including drugs, vaccinations, infections, and neoplasia. Toxic epidermal necrolysis therapy has been compared with partial-thickness burn injury treatment. The absence of burned tissue can dampen fluid requirements and metabolic needs of toxic epidermal necrolysis in comparison to equivalent burn injury. In the following case report, a 69-year-old woman with multiple medical problems developed toxic epidermal necrolysis after treatment with metolazone and phenytoin. Her measured energy expenditure (3360 kcal) was considerably higher than previously reported caloric expenditure in toxic epidermal necrolysis patients (2500 kcal).     

Toxic epidermal necrolysis due to lamotrigine

A 10-year-old girl developed a progressive rash and high fever more than a month after the start of lamotrigine as add-on medication for therapy-resistant epilepsy. A skin biopsy indicated toxic epidermal necrolysis (Lyell syndrome). Because her situation deteriorated and the lesions of the skin and mucosa progressed, she was transferred to a specialised centre for burn patients. Despite maximal supportive treatment, she died 3 weeks after the first skin lesions. Even with a low initial dosage of lamotrigine followed by a slow increase, a fatal toxic epidermal necrolysis is still possible. This should be kept in mind, especially in case of concurrent administration of valproic acid.     

Outbreak of Stevens-Johnson syndrome/toxic epidermal necrolysis associated with mebendazole and metronidazole use among Filipino laborers in Taiwan

OBJECTIVES: This study sought to identify the risk factors associated with an outbreak of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) among Filipino laborers in Taiwan. METHODS: Forty-six SJS/TEN patients were matched to 92 controls according to month of arrival in Taiwan, sex, and age. RESULTS: The odds ratio for development of SJS/TEN was 9.5 (95% confidence interval [CI] = 3.9, 23.9) among workers who had used both metronidazole and mebendazole sometime in the preceding 6 weeks. In addition, a gradient increase in the occurrence of SJS/TEN was found with an increasing level of exposure to metronidazole. CONCLUSIONS: This outbreak highlights the risk of SJS/TEN resulting from the use of both metronidazole and mebendazole and the need for control measures.     

Toxic epidermal necrolysis after topical intranasal application of mupirocin.

We describe a case of toxic epidermal necrolysis after intranasal application of mupirocin in a 76-year-old woman. The drug was given for eradication of methicillin-resistant Staphylococcus aureus.     

1例三氯乙烯致恶性大疱性表皮坏死松解症的护理

目的报告了1例三氯乙烯中毒致恶性大疱性表皮坏死松解症患者的护理个案。方法采用护肝、抗感染、大剂量甲基强的松龙等药物治疗,并实施严格的消毒隔离措施,加强皮肤和黏膜的护理、饮食护理、用药观察及心理护理等综合护理措施及对症支持治疗。结果皮质类固醇激素的及早应用是治疗本病的关键所在,经过积极治疗与长达3个多月的特级护理,患者救治成功。结论三氯乙烯药疹样皮炎明确诊断后积极治疗,做好基础护理的同时预防感染,正确的消毒隔离措施,重点加强皮肤护理,密切观察药物的疗效及不良反应,给予心理疏导及合理膳食是护理三氯乙烯中毒致恶性大疱性表皮坏死松解症患者的关键。     

Nutrition in Child Nutrition Programs:

This paper describes the role of recipe and menu development in meeting the nutrition objectives of Child Nutrition Programs. A model illustrating the importance of recipe and menu development in a school food service system is presented. Nutrition integrity standards and indicators of achievement related to recipe and menu development are discussed. Recommendations are made for ways in which education, research, and industry can increase support for recipe and menu development.