What is included in supportive systemic therapy for toxic epidermal necrolysis (TEN)?

Updated: Jul 01, 2021
  • Author: Samantha P Jellinek-Cohen, PharmD, BCPS (AQ-ID); Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

The patient should be placed in a heated environment to enhance reepithelialization. However, this may enhance water losses, and appropriate hydration must be maintained. Institute a bed warmer.

Saline applied to skin hourly is important, and then emollients are smeared. Chlorhexidine solution is used to bathe the patient's skin. Chlorhexidine mouthwash is administered 4 times a day, and white petrolatum is administered to the lips. Rinse the patient’s mouth frequently and apply a topical anesthetic or spray for buccal pain.

Provide daily physical therapy for range-of-motion exercises.

Place a Foley catheter and nasogastric tube only when needed. A urinary catheter should be placed in patients with urogenital involvement to decrease the risk of both infection and added injury. [48]

Energy requirements for patients with TEN must be carefully calculated and nutritional support provided. Protein loss can be significant. [30] Enteral nutrition through a nasogastric or naso jejnual tube is preferred to parenteral nutrition when oral mucosal involvement is severe, at 20-25 kcal/kg/day.


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