A burn center experience with toxic epidermal necrolysis

Toxic epidermal necrolysis, a disease that produces skin loss, was encountered in 18 patients in a burn center. Drugs were associated in all cases, but six patients had symptoms of fever or cough before drug exposure. Liver function abnormalities were noted in all 18 patients. Corticosteroids were ineffective in preventing skin loss, and sepsis caused death in 11 patients. The unacceptably high incidence of septic deaths led to the current protocol of debridement, rapid steroid taper, topical chemotherapy, and cover age with homograft or synthetic skin substitute. Gastrointestinal ulcerations may have been a part of the disease process or a complication of high-dose corticosteroids.