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References

DOI: 10.1111/bjd.14530Digital

• Patients with SJS/TEN with > 10% BSA epidermal loss should be admitted without delay to a burn centre or to an ICU with experience of treating patients with SJS/TEN and facilities to manage the logistics of extensive skin loss/wound care.
• A study by Shiga and Caforio of 21 patients with TEN with extensive epidermal loss recorded fluid requirements over the first 3 days of admission and estimated that replacement volumes can be determined by the following formula: 2 mL kg⁻¹ body weight/% BSA epidermal detachment.
• Fluid replacement can be guided by urine output and other end-point measurements.
• Provide continuous enteral nutrition throughout the acute phase of SJS/TEN, either by the oral route or via nasogastric feeding if the former is precluded by buccal mucositis.
• Patients with SJS/TEN who are insensible in bed should receive low molecular weight heparin as prophylactic anticoagulation against venous thromboembolism.
• During the acute phase of SJS/TEN, patients in whom enteral nutrition cannot be established may benefit from a proton pump inhibitor to protect against upper gastrointestinal stress ulceration.
• Patients with SJS/TEN who are neutropenic may benefit from the administration of recombinant human G-CSF.
• Use a patient-appropriate validated pain tool to assess pain in all conscious patients at least once a day.