orabase and Stevens-Johnson-Syndrome

The purpose of this study was to determine whether using Aquacel Ag (ConvaTec, Skillman, New Jersey) with Vaseline (Unilever, London, England) gauze instead of silver sulfadiazine cream (SSD) as the wound care protocol to treat toxic epidermal necrolysis (TEN) can improve wound healing, pain control, and reduction of labor costs.. A retrospective chart review.. A burn center with 2 plastic surgeons and 11 nursing staff.. A pathologist diagnosed TEN in 35 patients admitted to the burn center from 1995 to 2009.. Parameters included the patient's profile, dressing choice, severity-of-illness score for TEN, time to 95% re-epithelialization, visual analog scale pain scores before second dressing change, and labor cost. The exclusion criterion was wound care with neither Aquacel Ag with Vaseline nor SSD exclusively.. Twenty patients were enrolled in this study. In the group using Aquacel Ag with Vaseline gauze, the visual analog scale score was significantly less than that of the SSD group (P = .02). Labor costs were significantly lower in the Aquacel Ag with Vaseline gauze group (P < .01). Commencement of specific dressing to 95% re-epithelialization (P = .09) and time spent in the second dressing change (P = .05) had no statistical significance between the 2 groups.. This study showed that Aquacel Ag with Vaseline gauze decreased pain and labor costs but did not shorten wound healing time. Thus, Aquacel Ag with Vaseline gauze can be an efficient method for treating TEN wounds.

Topics: Adult; Aged; Anti-Infective Agents, Local; Carboxymethylcellulose Sodium; Child; Female; Humans; Male; Middle Aged; Occlusive Dressings; Petrolatum; Retrospective Studies; Silver; Silver Sulfadiazine; Stevens-Johnson Syndrome; Treatment Outcome; Wound Healing; Young Adult

To report three cases of bilateral microbial keratitis in eyes with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) induced by highly active antiretroviral therapy (HAART) in patients of acquired immune deficiency syndrome (AIDS).. A case series.. A detailed clinical examination and systemic review of all the three patients on HAART was performed. While one manifested with the more severe variant of TEN, two of these patients presented with SJS with ocular involvement. Despite withdrawal of nevirapine, the ocular surface disorder persisted. The entailing chronic epitheliopathy along with the compromised immune status led to the development of secondary microbial keratitis in all these cases.. The immune reconstitution occurring as a response to the antiretroviral therapy may potentially increase immunologically mediated diseases like SJS and TEN, which in turn may predispose the eye to develop corneal ulcer.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amnion; Anti-Bacterial Agents; Antiretroviral Therapy, Highly Active; Aza Compounds; Benzamidines; Carboxymethylcellulose Sodium; Cefazolin; Chlorhexidine; Corneal Ulcer; Drug Therapy, Combination; Fluoroquinolones; Humans; Male; Middle Aged; Moxifloxacin; Pain; Quinolines; Stevens-Johnson Syndrome; Tobramycin; Treatment Outcome; Tropanes; Visual Acuity

Toxic epidermal necrolysis (TEN) is a rare condition with potentially high mortality and involves severe exfoliative disease of the skin and mucous membranes induced by drugs. The reported fatality of TEN varies widely from 20% to 60%. The technique for TEN wound coverage described in this article involves the use of various dressings.. Nine women with histologically confirmed TEN (>30% total body surface area, TBSA) were treated at our burn intensive care unit. All patients received hydrotherapy and wounds were covered with Aquacel Ag and Vaseline gauzes onlay. Following this, elastic cotton bandage was wrapped around the dressing. The dressing was changed and the wound evaluated twice a week. Efficacy was established by the wound achieving>or=95% re-epithelialisation of the study area.. The mean age was 60.1 years (range from 7 to 88 years). The percentage of body surface area affected by epidermal slough ranged from 30% to 85% TBSA, with a mean of 51%. One patient expired due to severe sepsis on day 3. Eight patients achieved over 95% wound healing. All wounds healed well without the need for skin grafting. However, two of them expired on day 14 and day 20 because of pneumonia and retention of carbon dioxide, respectively. The average duration to achieve 95% wound healing was 10.4 days in eight cases (range from 7 to 14 days). No adverse reactions were noted.. Aquacel Ag dressing can be easily removed during hydrotherapy. The wound pain is reduced. By changing the dressing just twice a week, we were able to evaluate the wound directly, decrease the odour and increase the quality of life of the patients. In addition, lower frequency of dressing changes decreases the manpower requirements and is cost effective. Use of Aquacel Ag with Vaseline gauze is a good alternative for the management of TEN wounds.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carboxymethylcellulose Sodium; Child; Female; Humans; Hydrotherapy; Middle Aged; Occlusive Dressings; Petrolatum; Stevens-Johnson Syndrome; Treatment Outcome; Wound Healing; Young Adult

Toxic Epidermal Necrolysis (TEN) is life-threatening dermatological disease characterized by extensive destruction of the epidermis is associated with a 25-60% mortality rate in adults. We presented one patient with TEN with 86% skin slough treated successfully using AQUACEL Ag exclusively. All of the wounds were healed completely 8 days after onset of TEN. AQUACEL Ag is an efficient and cost-effective adjunct in the treatment of TEN.

Topics: Adult; Carboxymethylcellulose Sodium; Female; Follow-Up Studies; Humans; Occlusive Dressings; Stevens-Johnson Syndrome; Wound Healing