Management and Outcomes of Toxic Epidermal Necrolysis Treated in Burns Centres: A Systematic Review


Nancy Wei1, Philip Lee1, Ryan Tonkin 1, Andrea Issler-Fisher1,2, Jason Diab 1,2,
1The University Of Notre Dame, School Of Medicine, Sydney Australia
2Concord Repatriation General Hospital, Sydney Australia

Abstract

Introduction:
Toxic epidermal necrolysis (TEN) is a rare, potentially life-threatening dermatological condition characterised by mucocutaneous detachment of greater than 30% total body surface area (%TBSA). With a high mortality rate, TEN is often managed at burns centres with evidence suggesting better survival rates.

Method:
A systematic review was conducted using PubMed, MEDLINE, EMBASE, ScienceDirect and The Cochrane Library from 2012 – 2022. The primary objective was to analyse the clinical outcomes, management and mortality of TEN in burns centres.

Results:
A total of 12 papers, reporting outcomes in 273 patients were identified. Variations in treatment options including supportive therapy or systemic treatments that were utilised either individually or in combination, such as intravenous immunoglobulin, intravenous corticosteroids, cyclosporine, granulocyte colony-stimulating factor (G-CSF), and etanercept. The calculated cumulative mortality rate was 37%. Intravenous corticosteroids and intravenous immunoglobulin showed limited mortality improvement. Etanercept and cyclosporine demonstrated encouraging results, however this was observed in a relatively small subset of patients.

Conclusion:
This systematic review demonstrates the variation in management and mortality outcomes across management of TEN in burns centres with prospects for emerging immunomodulatory therapy. Our findings emphasise the importance of standardised protocols and evidenced-based interventions to optimise the management and improve prognosis of TEN patients within the burns centre setting.

Biography

Nancy Wei is a final year medical student at The University of Notre Dame, Australia. She is completing her clinical placements and studies in Melbourne, VIC, and plans to continue her ongoing training in Melbourne. She has an interest in Dermatology and general medicine.