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Ann Surg. Nov 1986; 204(5): 503–512.
PMCID: PMC1251332

Improved burn center survival of patients with toxic epidermal necrolysis managed without corticosteroids.


Fifteen consecutive patients with toxic epidermal necrolysis or the Stevens-Johnson syndrome managed without corticosteroids after transfer to the burn center (group 2) are compared to a previous consecutive group of 15 who received high doses of these drugs (group 1). Group 2 had a 66% survival, which was a significant improvement compared to the 33% survival in group 1 (p = 0.057). In group 1, mortality was associated with loss of more than 50% of the body surface area skin. In group 2, mortality was related to advanced age and associated diseases. Age, extent of skin loss, progression of skin loss after burn center admission, incidence of abnormal liver function tests, and the incidence of septic complications were not significantly different in the two groups (p greater than 0.10). The incidence of detected esophageal slough was similar in both groups. Nonsteroid (group 2) management was associated with a decreased incidence of ulceration of gastrointestinal columnar epithelium, Candida sepsis, and an increased survival after septic complications. The combined experience of these 30 patients suggests that corticosteroids are contraindicated in the burn center management of toxic epidermal necrolysis and the Stevens-Johnson syndrome.

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Selected References

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  • Anhalt G, Snelling CF. Toxic epidermal necrolysis. Case report. Plast Reconstr Surg. 1978 Jun;61(6):905–910. [PubMed]
  • Demling RH, Ellerbe S, Lowe NJ. Burn unit management of toxic epidermal necrolysis. Arch Surg. 1978 Jun;113(6):758–759. [PubMed]
  • Marvin JA, Heimbach DM, Engrav LH, Harnar TJ. Improved treatment of the Stevens-Johnson syndrome. Arch Surg. 1984 May;119(5):601–605. [PubMed]
  • LYELL A. Toxic epidermal necrolysis: an eruption resembling scalding of the skin. Br J Dermatol. 1956 Nov;68(11):355–361. [PubMed]
  • Assaad D, From L, Ricciatti D, Shapero H. Toxic epidermal necrolysis in Stevens--Johnson syndrome. Can Med Assoc J. 1978 Jan 21;118(2):154–156. [PMC free article] [PubMed]
  • Rasmussen J. Toxic epidermal necrolysis. Med Clin North Am. 1980 Sep;64(5):901–920. [PubMed]
  • Björnberg A. Fifteen cases of toxic epidermal necrolysis (Lyell). Acta Derm Venereol. 1973;53(2):149–152. [PubMed]
  • Finlay AY, Richards J, Holt PJ. Intensive therapy unit management of toxic epidermal necrolysis: practical aspects. Clin Exp Dermatol. 1982 Jan;7(1):55–60. [PubMed]
  • Ohlenschlaeger K. Toxic epidermal necrolysis and Stevens-Johnson's disease. Acta Derm Venereol. 1966;46(2):204–209. [PubMed]
  • Simons HM. Acute life-threatening dermatologic disorders. Med Clin North Am. 1981 Jan;65(1):227–243. [PubMed]
  • Nathan MD. Stevens-Johnson syndrome: Twenty-three cases and their otolaryngologic significance. Laryngoscope. 1975 Oct;85(10):1713–1724. [PubMed]
  • Daniels TE, Quadra-White C. Direct immunofluorescence in oral mucosal disease: a diagnostic analysis of 130 cases. Oral Surg Oral Med Oral Pathol. 1981 Jan;51(1):38–47. [PubMed]
  • Pullen H, Wright N, Murdoch JM. Hypersensitivity reactions to antibacterial drugs in infectious mononucleosis. Lancet. 1967 Dec 2;2(7527):1176–1178. [PubMed]
  • Lyell A. Toxic epidermal necrolysis (the scalded skin syndrome): a reappraisal. Br J Dermatol. 1979 Jan;100(1):69–86. [PubMed]
  • Rasmussen JE. Erythema multiforme in children. Response to treatment with systemic corticosteroids. Br J Dermatol. 1976 Aug;95(2):181–186. [PubMed]
  • Handwerger RL, Hambrick GW., Jr Recognizing and managing drug eruptions. Postgrad Med. 1972 Nov;52(5):119–125. [PubMed]
  • Pruitt BA, Jr, McManus WF, Kim SH, Treat RC. Diagnosis and treatment of cannula-related intravenous sepsis in burn patients. Ann Surg. 1980 May;191(5):546–554. [PMC free article] [PubMed]
  • Messer J, Reitman D, Sacks HS, Smith H, Jr, Chalmers TC. Association of adrenocorticosteroid therapy and peptic-ulcer disease. N Engl J Med. 1983 Jul 7;309(1):21–24. [PubMed]
  • Shaw DJ, Jacobs RP. Simultaneous occurrence of toxic hepatitis and Stevens-Johnson syndrome following therapy with sulfisoxazole and sulfamethoxazole. Johns Hopkins Med J. 1970 Mar;126(3):130–133. [PubMed]
  • Graham-Brown RA, Cochrane GW, Swinhoe JR, Sarkany I, Epsztejn LJ. Vaginal stenosis due to bullous erythema multiforme (Stevens-Johnson syndrome). Case report. Br J Obstet Gynaecol. 1981 Nov;88(11):1156–1157. [PubMed]
  • Santiago SM, Jr, Klaustermeyer WB, Brockman G. Pulmonary thromboembolism in erythema multiforme. West J Med. 1977 Jun;126(6):505–506. [PMC free article] [PubMed]
  • Wilmore DW. Nutrition and metabolism following thermal injury. Clin Plast Surg. 1974 Oct;1(4):603–619. [PubMed]
  • Andersen R, Bergan T, Halvorsen K, Kallings I, Orstavik I. Legionnaires' disease combined with erythema multiforme in a 3-year-old boy. Acta Paediatr Scand. 1981;70(3):427–430. [PubMed]
  • Williamson DM. Erythema multiforme in infectious mononucleosis. Br J Dermatol. 1974 Sep;91(3):345–346. [PubMed]
  • Kazmierowski JA, Wuepper KD. Erythema multiforme: immune complex vasculitis of the superficial cutaneous microvasculature. J Invest Dermatol. 1978 Dec;71(6):366–369. [PubMed]
  • Wuepper KD, Watson PA, Kazmierowski JA. Immune complexes in erythema multiforme and the Stevens-Johnson syndrome. J Invest Dermatol. 1980 May;74(5):368–371. [PubMed]
  • Hunt TK, Ehrlich HP, Garcia JA, Dunphy JE. Effect of vitamin A on reversing the inhibitory effect of cortisone on healing of open wounds in animals and man. Ann Surg. 1969 Oct;170(4):633–641. [PMC free article] [PubMed]
  • Rutten P, Blackburn GL, Flatt JP, Hallowell E, Cochran D. Determination of optimal hyperalimentation infusion rate. J Surg Res. 1975 May;18(5):477–483. [PubMed]

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