Spies M, Sanford A P, Aili Low J F, Wolf S E, Herndon D N
Shriners Hospitals for Children, Department of Surgery, University of Texas Medical Branch, Galveston, Texas 77550-2725, USA.
Pediatrics. 2001 Nov;108(5):1162-8. doi: 10.1542/peds.108.5.1162.
Toxic epidermal necrolysis (TEN) is a rare but life-threatening disease of the skin and mucous membranes. We report our experience in the treatment of pediatric TEN patients with early debridement of necrotic skin and coverage with human allograft skin.
From 1984 to 2000, 15 children (6 girls, 9 boys, 7.2 +/- 1.5 years) with a histologic diagnosis of TEN and involvement of >30% total body surface area were treated at the Shriners Hospitals for Children in Galveston. All were treated in a specialized pediatric burn intensive care unit after our standard treatment protocol, including operative debridement of sloughing skin and allografting within 24 hours of admission. Outcome parameters were mortality, length of hospital stay, wound healing, clinical complications, causative drugs, corticosteroid use, and delay in referral to a burn center.
Taking a new medication (antibiotics, anticonvulsive drugs) was associated with all cases of TEN. Patients who were treated with early debridement and coverage with allograft skin showed no wound infection, and overall mortality was 7%. Total length of hospital stay was 26 +/- 3 days. Long-term sequelae were changes in skin pigmentation (100%), ophthalmologic problems (40%), and diffuse itching early after wound healing (53%).
Although a rare disease in children, TEN was managed successfully in a burn center environment, using early debridement and wound coverage with allograft skin as a biological dressing. The use of corticosteroids and referral patterns seems unchanged during the past 2 decades, indicating an additional need for information and education about the disease.
中毒性表皮坏死松解症（TEN）是一种罕见但危及生命的皮肤和黏膜疾病。我们报告了采用早期坏死皮肤清创术并用同种异体人皮覆盖治疗儿童TEN患者的经验。
1984年至2000年，加尔维斯顿市施赖纳斯儿童医院收治了15名组织学诊断为TEN且全身表面积受累>30%的儿童（6名女孩，9名男孩，年龄7.2±1.5岁）。所有患者均按照我们的标准治疗方案在专门的儿科烧伤重症监护病房接受治疗，包括在入院24小时内对脱落皮肤进行手术清创并进行同种异体移植。观察指标包括死亡率、住院时间、伤口愈合情况、临床并发症、致病药物、皮质类固醇的使用以及转诊至烧伤中心的延迟情况。
所有TEN病例均与服用新药物（抗生素、抗惊厥药物）有关。接受早期清创并用同种异体皮肤覆盖治疗的患者未发生伤口感染，总体死亡率为7%。总住院时间为26±3天。长期后遗症包括皮肤色素沉着改变（100%）、眼科问题（40%）以及伤口愈合后早期的弥漫性瘙痒（53%）。
尽管TEN在儿童中是一种罕见疾病，但在烧伤中心环境中通过早期清创并用同种异体皮肤作为生物敷料覆盖伤口，成功地对其进行了治疗。在过去20年中，皮质类固醇的使用和转诊模式似乎没有变化，这表明对该疾病的信息和教育还需要进一步加强。
