Abstract

CASTILLO-MUNOZ, F.I.; CESPEDES-GUIRAO, F.J.; NOVO-TORRES, A.  and  LORDA-BARRAGUER, E.. Retrospective analysis of 23 years of toxic epidermal necrolysis in the Burn Unit of Alicante, Spain. Cir. plást. iberolatinoam. [online]. 2014, vol.40, n.3, pp.279-294. ISSN 1989-2055.  https://dx.doi.org/10.4321/S0376-78922014000300006.

Lyell's syndrome or Toxic Epidermal Necrolysis (TEN) is considered within the spectrum of severe cutaneous adverse reactions; it´s a rare disease but with a high mortality rate. Most of the cases are related to idiosyncratic drug reactions. The aim of this paper is to reflect the clinical experience with this pathology at the Burn Unit of the Universitary General Hospital of Alicante, Spain, for the past 23 years. We conduct a retrospective study, collecting epidemiological data, likely causative agents, additional tests, comorbidities, treatment and clinical evolution, including 16 patients with an average age of 53,19 years; 68,75% were females and 31,25% were males. Antibiotics were most commonly implicated drugs (31.25%), followed by nonsteroidal anti-inflammatory drugs (25%). During admission, 43,75% received systemic corticosteroids, 37,5% only supportive treatment and 25% intravenous immunoglobulin; 56.25% suffered some type of sequel, being the most frequent ocular involvement (18,75%). The SCORTEN (Severity of illness score for toxic epidermal necrolisys) was calculated for all patients in the first 24 hours of admission, the sum of the predicted probabilities of dying from NET it's 32%, higher than the actual data (mortality 25%). The use of systemic corticosteroids remains controversial, appearing in our study a greater number of infections and increased mortality associated with this treatment. Early admission in Burn or Intensive Care Unit, the prompt withdrawal of suspected drug, supportive treatment and fluid and electrolyte replacement, are considered crucial and first-line treatment in these patients. Different drug treatments have been described for the management of this condition without achieving a convincing role, so we considerer that new multicenter randomized prospective studies are required in the future. We propose in this paper a protocol for managing these patients.

Keywords : Lyell's syndrome; Toxic epidermal necrolysis; Adverse drug reactions; Adverse cutaneous reactions.

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