Toxic epidermal necrolysis: Use of Biobrane® for skin coverage reduces pain, improves mobilisation and decreases infection in elderly patients

IntroductionToxic epidermal necrolysis is a rare disease with high mortality due to generalised infection, sepsis or lung involvement, and requires discontinuation of all potentially triggering medications and intensive care in a specialised burn centre. Apart from wound care with antiseptics, wound coverage may be achieved with a skin substitute; treatments are compared with regard to infection, protein loss, re-epithelialisation and mortality.Patients and methodsOf 14 people with toxic epidermal necrolysis affecting >30% body surface area, eight received daily dressing changes using Lavasept® and six received wound coverage with Biobrane®. Demographic data, SCORTEN score, mortality, visual-analog pain scale, mobilisation, time to re-epithelialisation, serum protein, albumin, C-reactive protein and leukocytes, and body temperature were evaluated in all cases.ResultsMean age of patients was 68.0 ± 14.8 years, mean body surface area affected was 66.4%, median SCORTEN score was three and overall mortality was 36%. In the Biobrane® compared with the Lavasept® (control) group, mean pain was significantly reduced (2.9 versus 5.5 on the scale, p < 0.05), mobilisation was significantly earlier (walking at 3 days versus 7 days, p = 0.003), re-epithelialisation was complete in 12.5 days versus 16 days, and at 9 days there was reduced decrease of serum proteins and significantly lower levels of C-reactive protein and white cells (p < 0.05).ConclusionEarly wound coverage with synthetic skin substitute such as Biobrane® is beneficial compared with conservative antiseptic wound treatment, but mortality rate is not significantly different.