Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets (hemodynamic, neurologic, respiratory) and reassess frequently.
- Plan definitive source control or immunomodulation when indicated; document follow‑up and patient education.
Algorithm
- Stop suspected culprit drugs immediately; list all non‑essential meds.
- Admit to burn/ICU; calculate SCORTEN; begin aggressive wound and fluid management.
- Initiate early enteral nutrition and pain control; strict infection surveillance.
- Consider cyclosporine or etanercept in experienced centers; discuss IVIG on case basis.
- Plan ophthalmology/urogenital care to prevent sequelae; arrange rehab and dermatology follow‑up.
Clinical Synopsis & Reasoning
Life‑threatening epidermal necrosis usually triggered by medications. Stop culprit drug, admit to burn/ICU, apply SCORTEN for prognosis, and provide meticulous wound, fluid, and infection care. Consider cyclosporine or etanercept in selected cases; IVIG evidence mixed.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced or procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| Medication history 1–3 weeks prior | Etiology | High‑risk drugs (e.g., sulfonamides, allopurinol, anticonvulsants) | Identify culprit |
| SCORTEN variables | Prognosis | Age, TBSA, malignancy, HR, BUN, bicarb, glucose | Calculate on day 1 and 3 |
| Cultures only if infected | Infection control | Secondary sepsis risk | Avoid routine prophylactic antibiotics |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Cyclosporine 3–5 mg/kg/day | Immunomodulator | Days | May reduce mortality/time to re‑epithelialization | Monitor renal/BP |
| Etanercept 50 mg SC once (± repeat) | TNF‑α inhibitor | Days | Emerging evidence for benefit | Infection risk |
| IVIG 2 g/kg total (variable) | Immunotherapy | Days | Mixed evidence | Volume load, cost |
| Supportive burn‑style care | Protocolized | Immediate | Core of therapy | Fluids, temperature, nutrition, wound care |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.