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Toxic epidermal necrolysis clinical guidelines.

Abstract : Recommendations: Standards: 1) Cessation of causative medications is mandatory to halt progression of toxic epidermal necrolysis (TEN). 2) Early transfer to a burn unit or similarly qualified specialized center is the standard of care for TEN. Guidelines: 1) Tissue diagnosis by full-thickness punch biopsy is recommended for the diagnosis of TEN 2) Systemic corticosteroids are not recommended in the treatment of TEN 3) The use of empiric prophylactic antibiotics is not recommended in patients with TEN 4) Coverage of areas of desquamated skin may be attained with a number of dressings, including biological, biosynthetic, and silver or antibiotic-impregnated dressings. Frequent dressing changes with topical antimicrobial ointments or solutions are not recommended 5) Enteral nutrition is recommended for patients with TEN 6) The clinical scoring system SCORTEN may be useful in predicting mortality of patients with TEN, particularly when repeated daily 7) Long-term outpatient follow-up is important in TEN survivors to manage late complications and identify at-risk patients for post-discharge mortality 8) Ophthalmologic consultation is highly recommended for patients with conjunctival involvement. Dermatology/dermatopathology consultation may be considered to rule out non-TENS diseases.