21 Steroid therapy for TEN is reported as both controversial and no longer recommended; if used, it should be CHIR-99021 order within the first 48 hours of treatment because of the increased risk

of septic complications with an anti-inflammatory agent. Strict control of blood glucose levels is needed for patients with history of diabetes or on corticosteroids.22 For patients with extensive skin involvement, supportive care in an acute burn or intensive care unit is recommended for life support measures, pain management, and prevention of infection.23 Mechanical ventilation, fluid resuscitation with IV fluids or Ringer’s solution for electrolyte balance, anticoagulation with heparin to prevent thromboembolism, and supplemental nutrition via a nasogastric tube may be needed in severe cases.2 and 12 Antibiotic therapy Cyclopamine price is not prophylactic but dependent on clinical symptoms, including positive skin cultures, sudden drop in temperature, or deterioration of

patient’s medical condition.2 In order to prevent caloric loss and an increase in metabolic rate, a room temperature of 30 °C to 32 °C is also recommended.2 Clinical studies on the use of intravenous immunoglobulin for patients with SJS and TEN have shown mixed results. Successful treatment appears to be dose dependent (1 g/kg/day for 3 days with a total of 3 g/kg over 3 consecutive days), with early treatment recommended.24 Other medications that have been studied and found beneficial include IV infliximab, cyclosporine, and IV N-acetylcysteine.12 Acyclovir has been suggested for herpetic lesions in the

oral cavity.8 For severe cases involving loss of epidermis, wound management goals are to prevent fluid loss, prevent infection, and facilitate reepithelialization. Although patients with SJS and TEN are best treated in an acute burn center, there are some definite differences in their clinical presentation that affect treatment. For example, SJS and TEN epidermal involvement may continue to spread after admission; subcutaneous necrosis is deeper in burns, thereby creating subcutaneous edema that is not observed in SJS and TEN; fluid requirements for SJS and clonidine TEN are usually two-thirds to three-fourths those of burn patients with the same area involvement; and reepithelialization is usually faster in SJS and TEN because of more sparing of the hair follicles in the dermal layer.2 Skin lesions can be expected to heal in an average of 15 days; oral and pharyngeal lesions may take approximately 4 weeks longer.24 Debridement of detached epidermal tissue is controversial and usually not advisable in patients who have a positive Nikolsky sign.2 Collagen sheet dressings,13 Biobrane (Dow B. Hickam, Inc, Sugarland, TX, USA),8 and other occlusive nonadhesive wound coverings that prevent fluid loss and minimize pain with dressing changes have been recommended.