A Standardized Procedure of Dressing Management for Toxic Epidermal Necrolysis

Summary

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.

Abstract

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.

Introduction

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 TE....

Protocol

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....

Results

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.......

Discussion

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........

Materials

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
Medical  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 SHENG  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