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This is a standardized dressing protocol for patients with toxic epidermal necrolysis. This robust protocol utilizes silver ion dressings designed to accelerate healing and alleviate pain, minimizing hospital stays.
Toxic epidermal necrolysis (TEN) is a severe cutaneous adverse drug reaction with high mortality rates, demanding specialized wound care to address epidermal detachment and bullae formation. This study summarizes a standardized dressing management protocol to enhance the healing process, reduce complications, and improve patient comfort during dressing changes for TEN patients. The protocol emphasizes a systematic approach to patient preparation, environmental control, and the utilization of silver-ion-based dressing materials. Specifically, it integrates gentle cleansing techniques with a warmed povidone-iodine saline solution, precise necrotic tissue removal, and silver sulfadiazine lipid hydrocolloid dressings to maintain an optimal healing environment. The effectiveness of this protocol was further validated through a retrospective analysis, which showed a significant reduction in the onset of re-epithelization, wound healing time, and hospital stays, resulting in diminished pain during dressing changes. Furthermore, this protocol also provides tailored strategies for dressing changes in sensitive areas, ensuring comprehensive care. The standardized protocol streamlines the dressing process and contributes to more efficient allocation of healthcare resources, establishing a robust foundation for TEN treatment that can be adopted in clinical practice and inform future research.
Toxic epidermal necrolysis (TEN) is a severe cutaneous adverse drug reaction, distinguished by widespread epidermal detachment and bullae formation, which confers an increased susceptibility to complications such as infections and derangements in fluid and electrolyte balance1. This condition invariably precipitates a host of complications, notably infection and fluid and electrolyte imbalances, with the severity of TEN being inextricably linked to the manifestation and progression of such complications. The literature has documented that TEN mortality rates span from 12% to 30%2. Areas of diffuse erythema are seen in TEN, with individual macular lesions at the periphery. Large, flaccid blisters are formed from the detachment of the epidermis from the underlying dermis. The roofs of the blisters turn necrotic and large 5 cm sheets show denudation of the epidermis3. The efficacious management of TEN is predicated upon the prompt discontinuation of the inciting drug regimen and meticulous wound care4. Of particular note, wound care assumes a central position in the treatment paradigm for TEN patients. Its principal objectives are to stanch occult fluid loss, forestall the onset of sepsis, and foster epithelial regeneration5. The overarching principles governing wound care encompass safeguarding the underlying exposed dermis, attenuating the potential for infection, mitigating the risks of pigmentary alterations and scarring, and optimizing the process of epithelial reformation. More specifically, wound care resides within the purview of surgical debridement, and its operational modalities entail selecting either debridement procedures or supportive dressings. This translates into either the excision of detached and necrotic epidermal tissues or the retention of viable epidermis as a biological dressing, followed by the application of supportive dressings to facilitate epithelial reformation4.
The extensive skin lesions associated with TEN are particularly susceptible to being invaded by microbes such as bacteria, fungi, and other pathogens6. Conventional dressings, such as gauze and cotton pads, exhibit limited water absorption capabilities and have a propensity to adhere to wound surfaces, leading to iatrogenic trauma, exacerbated pain levels, and bleeding during dressing changes7. These materials provide inadequate air permeability, which impedes wound healing8. Furthermore, traditional dressings are ineffective at preventing and managing infections, increasing the risk of wound sepsis9. Their inability to facilitate wound healing results in prolonged convalescence, increased patient discomfort, and higher healthcare costs10.
Novel dressings, such as zinc oxide talcum powder wraps and silver ionic dressings, have been investigated for TEN management11. Notably, silver sulfadiazine lipid hydrocolloid dressings dressing, a typical silver ionic dressing that sustains the release of silver sulfadiazine, has shown promise in maintaining adequate antibacterial levels, promoting a moist healing environment, and decreasing irritation and pain during dressing changes12,13,14,15. Recent studies suggest that silver sulfadiazine lipid hydrocolloid dressings can reduce healing time, infection rates, and patient discomfort compared to traditional dressing16,17. However, standardized dressing change protocols still need to be developed for TEN patients.
At present, there is a lack of standardized protocols for the wound care of patients with toxic epidermal necrolysis (TEN). Moreover, wound management practices differ among various medical units. Consequently, the establishment of standardized wound management for TEN patients constitutes a crucial yet unfulfilled clinical priority18. The primary aim of this research is to standardize the wound dressing change procedures for TEN patients. Specifically, it endeavors to compare the wound healing time between two different dressing change regimens: one centered around silver sulfadiazine liposome hydrocolloid dressing, and the other being the conventional dressing change approach. The secondary objective is to investigate the efficacy of silver sulfadiazine liposome hydrocolloid dressing in facilitating wound healing in these patients.
All procedures performed in this study comply with the ethical standards of the First Affiliated Hospital of Chongqing Medical University and the Declaration of Helsinki and its later amendments or similar moral standards. This study was approved by the ethics committee of Chongqing Medical University (Number: 2024-155-01), Participants were informed of the process, content, and possible medical phenomena before the start of the trial to ensure their right to know. Patients and their families were consulted to determine their willingness to participate in the trial activities. Before the enrollment of this patient, their informed consent for the use of photographs and participation in this research was obtained. This dressing management protocol was primarily designed for patients diagnosed with TEN. However, this protocol is also applicable for patients with extensive body areas of epidermolysis, such as pemphigus, bullous pemphigoid, and epidermolysis bullous.
1. Preparations
2. Skin cleansing and disinfection
3. Dressing change procedures
4. Efficacy and number of dressing changes
5. Dressing change at particular sites
We retrospectively compared the outcomes of this new method (based on silver sulfadiazine lipid hydrocolloid dressings dressing) with the conventional method (which did not involve silver sulfadiazine lipid hydrocolloid dressings dressing or sterile cotton pads) throughout the years 2023-2024. Sixty patients with toxic epidermal necrolysis (TEN) from the Dermatology Department of the First Affiliated Hospital of Chongqing Medical University were enrolled for statistical analysis. Mean values, standard deviations (SD), an...
TEN is a rare but devastating drug reaction characterized by extensive skin detachment affecting more than 30% of the body's surface area and the mucous membranes18. TEN is associated with severe complications, like sepsis with a mortality rate of 14%-30%. It has been reported that mortality is strongly linked with the areas of detached skin because the widespread skin bullae significantly increases the risk of infection due to the loss of the protective skin barrier20....
The authors declare that they have no competing interests.
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Name | Company | Catalog Number | Comments |
0.9% sodium chloride | SOUTHWEST PHARMACEUTICAL Co.,Ltd. | ||
Bactroban ointment | Tianjin Shike Pharmaceutial Co.,Ltd. | ||
Disposable Medical Kit (a dressing change box with sterile scissors) | Zhende Medical Co.,Ltd. | GB/T HYA-15 | |
Fu fang Comfrey oil | Jian Min Ji Tuan Ye KaiTaiGuoYao Co.,Ltd. | GBZ20044385 | |
MedicalΒ Swab | Zhende Medical Co.,Ltd. | 6926515436841 | |
petroleum jelly oil gauze | Henan PiaoAn Group Co.,Ltd. | GB20153140848 | |
Povidone-iodine | SHANDOING LIERKANG TECHOLOGY Co.,Ltd. | ||
rb-bFGF | ZHU HAi Yi SHENGΒ BIOLOGICAL MEDICAL Co.,Ltd. | GBS1098077 | |
silver sulfadiazine lipid hydrocolloid dressings | LABORATOIRES URO | 3546895089623 | |
Single-Use Sterile Rubber Surgical Gloves (both sterile and film) | SHANDOING YU YUAN RBBER GLOVES Co.,LTD | GB/T 7543-2020 | |
Sterile Dispensing Syringe for Single Use (empty needles) | SHANDON WEIGAO GROUP MEDICAL POLYER Co.,LTD | GB/T 20142140076 | |
sterile gauze rolls | Zhende Medical Co.,Ltd. | 6959385745812 |
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