Elkharaz S, Abdel-Razek E M, Eldin A, Abdel-Razek A M
King Saud Hospital, Unizah, Qassim, Kingdom of Saudi Arabia.
Ann Burns Fire Disasters. 2006 Dec 31;19(4):180-7.
Patients suffering from considerable cutaneous loss must be treated under strict aseptic conditions and with positive pressure ventilation, which is available in burns units. The differentiation of severe bullous skin diseases remains a challenge for the clinician. We report seven cases of severe bullous skin diseases in a paediatric age group treated in a burns unit with the cooperation of a paediatric intensive care unit (King Saud Hospital, Unizah, Kingdom of Saudia Arabia) between 2001 and 2005. Toxic epidermal necrolysis (Lyell's syndrome) was encountered in five cases, staphylococcal scalded-skin syndrome in one, and generalized drug eruption in one. The mortality rate was 14% (one of the seven patients). Most of the children presented with about 35% desquamation and 45% intact bullous formation (70-80% total body surface area involvement). The majority presented after the sudden onset of high fever, signs of systemic toxicity, and intense mucocutaneous exfoliation. The diagnosis was confirmed by skin biopsy and culture swabs. All the patients were managed as for mixed second-degree burns with regard to fluid calculation and hydrotherapy. We used the closed technique for dressing. The results are presented, and the literature was searched for similar cases reported in other parts of the world. The importance of diagnosis and appropriate treatment of the condition is emphasized.
患有大面积皮肤缺损的患者必须在严格的无菌条件下并采用正压通气进行治疗，这种条件在烧伤病房是具备的。对于临床医生来说，鉴别严重的大疱性皮肤病仍然是一项挑战。我们报告了2001年至2005年间在沙特阿拉伯王国乌奈宰的沙特国王医院烧伤病房与儿科重症监护病房合作治疗的7例儿科年龄组严重大疱性皮肤病病例。其中5例为中毒性表皮坏死松解症（莱尔综合征），1例为葡萄球菌烫伤样皮肤综合征，1例为全身性药疹。死亡率为14%（7例患者中的1例）。大多数儿童出现约35%的脱皮和45%的完整水疱形成（累及体表面积70 - 80%）。大多数患者在突然高热、全身中毒症状及强烈的黏膜皮肤剥脱后就诊。通过皮肤活检和培养拭子确诊。所有患者在液体计算和水疗方面按照混合二度烧伤进行处理。我们采用封闭技术进行包扎。现将结果呈现，并检索世界其他地区报道的类似病例的文献。强调了该病诊断和恰当治疗的重要性。
