Plasmapheresis as an adjunct treatment in toxic epidermal necrolysis

Background: Toxic epidermal necrolysis (TEN) is a severe, progressive disea se characterized by the sudden onset of skin necrosis. It is frequently ass ociated with systemic involvement and has a high rate of morbidity and mort ality. Standard therapy includes meticulous wound care, fluid replacement, and nutritional support in an intensive care setting. Objective: We evaluated the outcomes of patients treated in a burn unit for TEN over a 9-year period and compared the outcomes of a subset of patients treated with plasmapheresis with those managed by conventional means. Methods: The records of 16 patients with a diagnosis of TEN obtained from a computerized database were reviewed. Parameters recorded included extent o f body surface area involvement and number of mucous membranes involved at admission, complications such as sepsis or need for mechanical ventilation, length of stay, and disposition. Results: Sixteen patients were included in this study. Ten were treated wit h conventional support measures alone. Six were treated with plasmapheresis . The average age was 42.4 years; the male/female ratio was 1:2.2. Sulfamet hoxazole/trimethoprim was implicated in causation in 6 patients. The averag e extent of involvement on admission in all patients was 51.5% total body s urface area. The average length of stay in all patients was 14.8 days. Eigh t patients (50%) were discharged home, 4 (25%) were discharged to a rehabil itation facility, and 4 (25%) died (2 of sepsis, 2 of cardiopulmonary arres t). None of the plasmapheresis-treated patients died. Conclusion: Plasmapheresis is a safe intervention in extremely ill TEN pati ents and may reduce the mortality in this severe disease. Prospective studi es are needed to further define its usefulness.