Hyperbaric oxygen treatment of toxic epidermal necrolysis

Hyperbaric oxygen, useful in treating patients with extensive burns, was used alone in the treatment of three patients with drug-induced toxic epidermal necrolysis. These conditions, although they have different causes, result in a similar biological state of denuded dermis. The therapy was performed in a pressure chamber with pure oxygen at 2 atm for sixty to 120 minutes once a day. Re-epithelialization occurred quickly in all patients and was complete after approximately ten treatments. Our experience, although limited and uncontrolled, points to a beneficial effect of hyperbaric oxygen in the treatment of toxic epidermal necrolysis. Activation of dermal metabolism, enhancement of epidermal regeneration, antishock and antiseptic action, and possibly an immunosuppressive effect are properties of hyperbaric oxygen that may account for its efficacy in the management of toxic epidermal necrolysis.     

Universal cutaneous depigmentation following phenytoin-induced toxic epidermal necrolysis

A 10-year-old black girl with a severe hypersensitivity reaction to phenytoin is described. Adverse effects included interstitial nephritis, hepatitis, and toxic epidermal necrolysis. An apparently permanent sequela of universal cutaneous depigmentation developed. Although the presence of clear cells in the basal layer of the epidermis suggested that melanocytes might still be present, these clear cells were shown, by electron microscopy, to be Langerhans cells and not melanocytes. This patient demonstrates a unique outcome, not previously described in the literature.     

IVIG for the treatment of toxic epidermal necrolysis

Intravenous immunoglobulin (IVIG) has been proposed as a treatment for toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS). A number of retrospective and prospective studies have been conducted, with varying levels of evidence for the efficacy of IVIG. Recent publications provide opposing conclusions. A multi-center, comparative, long-term analysis needs to be conducted to determine the role of IVIG in the management of patients with SJS/TEN.     

Chloroquine-induced toxic epidermal necrolysis

Two female patients aged 25 and 12 years suffering from malaria presented with picture of Stevens Johnson syndrome. Each of them had received daily doses of chloroquine phosphate by intramuscular injection for 3 days. They progressed to toxic epidermal necrolysis and could not be saved despite best of efforts.     

Management of toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) is a medical emergency requiring the combined efforts of specialists from multiple disciplines. A basic guide to the management of the seriously ill patient with this disorder is provided.     

Sparfloxacin induced toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) is a life-threatening cutaneous adverse drug reaction. TEN is known to occur with the fluoroquinolone class of antibiotics, but only four cases of sparfloxacin induced TEN have been reported to the WHO database. This is another case report of sparfloxacin induced TEN.     

Plasmapheresis in toxic epidermal necrolysis

Background The treatment of toxic epidermal necrolysis (TEN) is usually based on the removal of the offending drug(s), fluid replacement, nutritional support, and local management. The mortality and morbidity, however, remain high and the death rate may be reduced to 10% only in special centers that use biologic dressings. Plasma exchange (PE) was proven efficacious in small series of patients and of no particular value in others. Methods Seven patients suffering from severe TEN covering 30%–80% of body surface area and having two or four mucous membranes involved, were included in this open study. Malignancy (Hodgkin's disease, brain tumor) and a variety of medicaments (carbamazepine, allopurinol, diphenylhydantoin, cefaclor, amoxicyllin with clavullanic acid) were considered as causally implicated. One to four PEs of 2.5 L were given on alternate days in six patients and on a daily basis in the seventh. Results All patients recovered successfully from their disease. No new lesions appeared after the first PE in four patients. Neither adverse reactions from this therapy nor sequelae from TEN were observed after a long follow-up lasting up to 8 years. Conclusions Although PE is expensive and requires easy venous access to be performed, it could be listed in the first line of TEN therapy. The method is safe and efficacious, providing prompt relief from pain and rapid cessation of necrolysis. The alternate day PEs are considered preferable to the everyday regimen.