Bridging Resource Gaps in Toxic Epidermal Necrolysis Management: A Case Report Highlighting Innovative Care

Abstract

Toxic epidermal necrolysis (TEN) is a rare but potentially life-threatening dermatological condition. It is characterised by diffuse exfoliation of >30% of the skin and mucous membranes due to immune-mediated destruction of the epidermis. It is thought to be due to a hypersensitivity reaction to a variety of medications. The mainstay of treatment involves withdrawal of the potential offending agent, supportive care and use of non-adherent dressings. Pre-packaged dressings are expensive or not readily available in our locality; hence, the need for improvisation, to manage the condition and improve outcomes. We report a case of TEN in a 2-year old female who presented with a 6-day history of fever and a rash on the trunk, for which mother applied topical calamine lotion, gave an oral herbal concoction for 3 days, with no improvement, after which she commenced amoxicillin + clavulanic acid. Twenty-four hours later, the rash progressed to involve the whole body. On presentation, she had extensive exfoliation of >70% of the body surface area, with multiple bullae, intraoral ulcers and excoriation of the eyelids and genitals. She was admitted into the Paediatric Intensive Care Unit, where she received intravenous hydration and antibiotics, micronutrients, nasogastric feeds and eye care. The skin was cleaned daily with 0.9% saline and dressed with petroleum jelly-impregnated gauze prepared at the Central Sterilising Services Department of the hospital. Skin ulcers resolved, and she was discharged after 6 weeks. In resource-poor settings such as ours, cheaper, sterile locally available materials could be used for dressing to improve outcomes.