The role of nanocrystalline silver dressings in the management of Stephen Johnson/toxic epidermal necrolysis overlap or toxic epidermal necrolysis

Abstract

Introduction: Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome are severe mucocutaneous adverse drug reactions causing widespread keratinocyte apoptosis. Immune therapies which target the underlying disease process have been used to manage TEN, including intravenous immunoglobulin (IVIg), cyclosporine and corticosteroids, however, some controversy exists about the role of these medications.1 Current best management is through early recognition and cessation of the causative drug2 with the patient ideally being treated in a burns intensive care unit.3 Advances in dressing materials have resulted in non-adherent nanocrystalline silver containing gauzes being increasingly commonly used because of their broad antimicrobial effects.4 We question if it is the antibacterial effect of silver alone, or is it the possible antiinflammatory effects that benefit TEN patients. Method: A retrospective case review of patients admitted to Royal North Shore Hospital between 2011-2013 with the diagnosed with SJS/TEN crossover or TEN was performed. Results: Nine patients with a mean age of 63.5 years (range 23 to 95) were included in this case series. The majority of patients were female (77{%}). In all patients, the causative medication was identified and ceased as soon as possible. SCORTEN varied between 0 and 5 and the total body surface area percentage ranged from 10{%} to 98{%}. Intravenous immunoglobulin was administered to patients with a BSA involvement >30{%}. Seven of the nine patients were also administered systemic steroids and half were commenced on systemic antimicrobials. Nanocrystalline silver impregnated gauze dressings (ActicoatTM) were used in all patients.