Toxic epidermal necrolysis (TEN) is a severe cutaneous reaction with an estimated incidence of 0.4 to 1.2 cases per million person-years. Its etiologic features are primarily drug related, most commonly caused by sulfonamides, anticonvulsants, nonsteroidal anti-inflammatory drugs, and allopurinol.1
Therapy includes supportive care with aggressive fluid replacement, nutritional support, environmental temperature control, and antibiotic treatment as indicated.1 Controversy exists on how best to manage cutaneous involvement. We report our experience with a new dressing originally designed for patients with burns. This dressing (Soft-Sorb, De Royal Industries Inc, Powell, Tenn) can be impregnated with 0.5% silver nitrate solution (Figure 1) and allows for a moist wound-healing environment. Partially fitted, it can be left in place for 2 to 3 days, which prevents further damage to the skin and decreases the labor required.
Lehrer-Bell KA, Kirsner RS, Tallman PG, Kerdel FA. Treatment of the Cutaneous Involvement in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis With Silver Nitrate–Impregnated Dressings. Arch Dermatol. 1998;134(7):877-879. doi: