Treatment of extensive toxic epidermal necrolysis in children

Objective. Toxic epidermal necrolysis (TEN) is a rare but life-threatening disease of the skin and mucous membranes. We report our experience in the t reatment of pediatric TEN patients with early debridement of necrotic skin and coverage with human allograft skin. Methods. From 1984 to 2000, 15 children (6 girls, 9 boys, 7.2 +/- 1.5 years ) with a histologic diagnosis of TEN and involvement of >30% total body sur face area were treated at the Shriners Hospitals for Children in Galveston. All were treated in a specialized pediatric burn intensive care unit after our standard treatment protocol, including operative debridement of slough ing skin and allografting within 24 hours of admission. Outcome parameters were mortality, length of hospital stay, wound healing, clinical complicati ons, causative drugs, corticosteroid use, and delay in referral to a burn c enter. Results. Taking a new medication (antibiotics, anticonvulsive drugs) was as sociated with all cases of TEN. Patients who were treated with early debrid ement and coverage with allograft skin showed no wound infection, and overa ll mortality was 7%. Total length of hospital stay was 26 +/- 3 days. Long- term sequelae were changes in skin pigmentation (100%), ophthalmologic prob lems (40%), and diffuse itching early after wound healing (53%). Conclusion. Although a rare disease in children, TEN was managed successful ly in a burn center environment, using early debridement and wound coverage with allograft skin as a biological dressing. The use of corticosteroids a nd referral patterns seems unchanged during the past 2 decades, indicating an additional need for information and education about the disease.