Treatment of toxic epidermal necrolysis in a burn center.

The toxic epidermal necrolysis syndrome (TENS) is one of several clinically similar severe acute exfoliative skin disorders which have become of increasing interest to burn surgeons in recent years. Recognition of a clinical course similar to extensive second-degree burns has resulted in the development of treatment protocols which are best carried out in a burn unit by personnel experienced in critical care techniques, the management of major fluid and electrolyte derangements, the intensive nutritional support of critically ill patients, and the management of extensive cutaneous injuries with ready access to biologic wound dressings (homografts, xenografts). Current evidence suggests that TENS is a CD8 lymphocyte mediated reaction triggered by exposure to certain drugs in most instances. The target organs of the immune reaction are skin and mucus membranes. Treatment in burn units appears to have contributed significantly to the increasing survival of patients with this devastating and potentially lethal illness.