Toxic epidermal necrolysis (TEN) is an exfoliative disorder associated with epidermal slough and systemic toxicity. As of 1986, the literature has advocated early burn center transfer and has rejected the use of
steroids. We questioned whether
therapy for TEN has changed to reflect these concepts. All cases of TEN referred to our tertiary burn center since 1988 were reviewed. The history was evaluated for
steroid usage and timing of burn center transfer.
Drug exposures, septic complications, and deaths were noted. Statistics are expressed as mean +/- SD. Fourteen cases of TEN were identified. Transfer was delayed more than 2 days in 10 (72%) instances. Mean delay was 4.4 +/- 2.7 days. Half received
steroids. There were three deaths (21%).
Pneumonia developed in five patients (36%),
urinary tract infections developed in three (21%) patients, seven (50%) patients required intubation, and three (21%) required
hemodialysis. No differences in mortality rates or infectious complications were noted in patients who received
steroids or who were transferred late. Septic complications occur frequently in TEN. Delay in transfer and initiation of
steroids at referring institutions are common. Early burn center referral and avoidance of
steroids needs to be reiterated at the level of the referring physician.