Oral manifestations and management of toxic epidermal necrolysis in an intensive care unit: case report
DOI:
https://doi.org/10.33448/rsd-v11i9.20338Keywords:
Toxic epidermal necrolysis; Drug hypersensitivity; Intensive care unit; Oral manifestations; Photobiomodulation; Wound healing.Abstract
Toxic epidermal necrolysis (TEN) is a mucocutaneous disorder characterized by the detachment of epidermal and mucous tissues and areas of necrosis, resulting from hypersensitivity reactions to different drugs. We report a clinical case of a 19-year-old male patient diagnosed with TEN, with 90% involvement of the body surface and severe oral involvement. The patient was monitored by dentists from the multidisciplinary team of an intensive care unit, where adjuvant treatment was performed through photobiomodulation to control pain and regenerate the oral mucosa. The case represents the importance of early performance in oral TEN injuries and the role of the multidisciplinary team for comprehensive treatment.
References
Bellissimo-Rodrigues, W. T., Menegueti, M. G., Gaspar, G. G., de Souza, H. C. C., Auxiliadora-Martins, M., Basile-Filho, A., Martinez, R., & Bellissimo-Rodrigues, F. (2018). Is it necessary to have a dentist within an intensive care unit team? Report of a randomised clinical trial. International Dental Journal, 68(6), 420–427.
Blum, D. F. C., Da Silva, J. A. S., Baeder, F. M., & Bona, A. Della. (2018). The practice of dentistry in intensive care units in Brazil. Revista Brasileira de Terapia Intensiva, 30(3), 327–332.
Cabañas Weisz, L. M., Miguel Escuredo, I., Ayestarán Soto, J. B., & García Gutiérrez, J. J. (2020). Toxic epidermal necrolysis (TEN): Acute complications and long-term sequelae management in a multidisciplinary follow-up. Journal of Plastic, Reconstructive and Aesthetic Surgery, 73(2), 319–327.
Chang, W. C., Abe, R., Anderson, P., Anderson, W., Ardern-Jones, M. R., Beachkofsky, T. M., Bellón, T., Biala, A. K., Bouchard, C., Cavalleri, G. L., Chapman, N., Chodosh, J., Choi, H. K., Cibotti, R. R., Divito, S. J., Dewar, K., Dehaeck, U., Etminan, M., Forbes, D., … Carleton, B. C. (2020). SJS/TEN 2019: From science to translation. Journal of Dermatological Science, 98(1), 2–12.
Charlton, O. A., Harris, V., Phan, K., Mewton, E., Jackson, C., & Cooper, A. (2020). Toxic Epidermal Necrolysis and Steven-Johnson Syndrome: A Comprehensive Review. Advances in Wound Care, 9(7), 426–439.
Dal Prá, K. J., de Assis Tristão, S. da S. S., Franco, J. B., Matias, D. T., Carrillo, C. M., de Melo Peres, M. P. S., & Ribas, P. F. (2020). Oral management of pemphigus vulgaris in the intensive care unit. Special Care in Dentistry, 40(3), 280–284.
Franco, J. B., Melo Da Costa, S., Jales, P., Zambon, C. E., José, F., Fujarra, C., Vieira Ortegosa, M., Fernandes, P., Guardieiro, R., Matias, D. T., Siqueira De, M. P., & Peres, M. (2014). Higiene bucal para pacientes entubados sob ventilação mecânica assistida na unidade de terapia intensiva: proposta de protocolo Oral hygiene for intubated patients assisted with mechanical ventilation in intensive care unit: proposal protocol. Arq Med Hosp Fac Cienc Med, 59(3), 126–157.
Kim, M. M., Barnato, A. E., Angus, D. C., Fleisher, L. F., & Kahn, J. M. (2010). The effect of multidisciplinary care teams on intensive care unit mortality. Archives of Internal Medicine, 170(4), 369–376.
Lee, H. Y., Walsh, S. A., & Creamer, D. (2017). Long-term complications of Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN): the spectrum of chronic problems in patients who survive an episode of SJS/TEN necessitates multidisciplinary follow-up. British Journal of Dermatology, 177(4), 924–935.
Lin, C. C., Chen, C. B., Wang, C. W., Hung, S. I., & Chung, W. H. (2020). Stevens-Johnson syndrome and toxic epidermal necrolysis: risk factors, causality assessment and potential prevention strategies. Expert Review of Clinical Immunology, 16(4), 373–387.
Papp, A., Sikora, S., Evans, M., Song, D., Kirchhof, M., Miliszewski, M., & Dutz, J. (2018). Treatment of toxic epidermal necrolysis by a multidisciplinary team. A review of literature and treatment results. Burns, 44(4), 807–815.
Rabello, F., Araújo, V. E., & Magalhães, S. M. S. (2018). Effectiveness of oral chlorhexidine for the prevention of nosocomial pneumonia and ventilator-associated pneumonia in intensive care units: Overview of systematic reviews. International Journal of Dental Hygiene, 16(4), 441–449.
Rocha, A. L., De Souza, A. F., Nunes, L. F. M., Cunha, N. D. de S., Lanza, C. R. M., Travassos, D. V., & da Silva, T. A. (2019). Treatment of oral manifestations of toxic epidermal necrolysis with low-level laser therapy in a pediatric patient. Pediatric Dermatology, 36(1), e27–e30.
Schwartz, R. A., McDonough, P. H., & Lee, B. W. (2013). Toxic epidermal necrolysis: Part II. Prognosis, sequelae, diagnosis, differential diagnosis, prevention, and treatment. Journal of the American Academy of Dermatology, 69(2), 187.e1-187.e16.
Sedghizadeh, P. P., Kumar, S. K. S., Gorur, A., Mastin, C., & Boros, A. L. (2008). Toxic epidermal necrolysis with a rare long-term oral complication requiring surgical intervention. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 105(4), 29–33.
Seminario-Vidal, L., Kroshinsky, D., Malachowski, S. J., Sun, J., Markova, A., Beachkofsky, T. M., Kaffenberger, B. H., Ergen, E. N., Mauskar, M., Bridges, A., Calhoun, C., Cardones, A. R., Chen, S. T., Chodosh, J., Cotliar, J., Davis, M. D. P., DeNiro, K. L., Dominguez, A. R., Eljure-Téllez, J., … Micheletti, R. G. (2020). Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults. Journal of the American Academy of Dermatology, 82(6), 1553–1567.
Simões, A., De Freitas, P. M., Bello-Silva, M. S., Tunér, J., & De Paula Eduardo, C. (2011). Laser phototherapy for stevens-johnson syndrome: A case report. Photomedicine and Laser Surgery, 29(1), 67–69.
Soares, R. G., Farias, L. C., da Silva Menezes, A. S., de Oliveira e Silva, C. S., Tabosa, A. T. L., Chagas, P. V. F., Santiago, L., Santos, S. H. S., de Paula, A. M. B., & Guimarães, A. L. S. (2018). Treatment of mucositis with combined 660- and 808-nm-wavelength low-level laser therapy reduced mucositis grade, pain, and use of analgesics: a parallel, single-blind, two-arm controlled study. Lasers in Medical Science, 33(8), 1813–1819.
Sonis, S. T., Hashemi, S., Epstein, J. B., Nair, R. G., & Raber-Durlacher, J. E. (2016). Could the biological robustness of low level laser therapy (Photobiomodulation) impact its use in the management of mucositis in head and neck cancer patients. Oral Oncology, 54, 7–14.
Woolum, J. A., Bailey, A. M., Baum, R. A., & Metts, E. L. (2019). A Review of the Management of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Advanced Emergency Nursing Journal, 41(1), 56–64.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Ketelin Dal Prá; Stefanny da Silva Santucci Assis Tristão; Juliana Bertoldi Franco; Diogo Toledo Matias; Maria Paula Siqueira de Melo Peres; Priscila Fernandes Ribas
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.