Topical treatment options for drug-induced toxic epidermal necrolysis (TEN)

Importance of the field: Drug-induced toxic epidermal necrolysis (TEN) is a dreadful skin condition. The mortality rate of 25 - 30% is mainly due to both metabolic failures and septicemia following loss of epidermal integrity. Topical treatments are important options in these patients. Areas covered in this review: Topical TEN care includes specific bedding, debridement of epidermal necrosis, applications of bioactive skin substitutes or semi-synthetic and synthetic dressings, as well as antiseptic and antibiotic agents. What the reader will gain: In the early exudating phase of TEN, the use of air-fluidized bed combined with gentle debridement are recommended. Next, an alternating pressure mattress and silver impregnated absorbent dressings should be used. During the re-epithelialization phase, antiseptic or antibiotic creams overlaid with nonadherent dressings favor an optimized moist and bacteria-controlled environment. Take home message: A suitable topical treatment is mandatory in TEN. Skin care procedures must be managed according to the skin condition corresponding to the initial highly exudating/necrotic phase, the secondary moderately exudating stabilized phase and the later re-epidermization phase. Bedding modalities, debridement procedures, applications of bioactive, semi-synthetic and synthetic dressings (silver-impregnated or not) and antiseptic/antibiotic creams should be adapted accordingly.