Clinical Utility of Store-and-Forward Inpatient Teledermatology for Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis Care in the Burn Unit
Selina J. Chang, Vrusha K. Shah, Joseph C. EnglishBackground:
Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatologic emergencies that require rapid diagnosis and specialized care, but access to inpatient dermatology consults is often limited. While store-and-forward inpatient teledermatology (SAFIT) has been used for triaging suspected cases, its role in ongoing disease management remains unclear.
Objective:
To characterize the clinical characteristics, treatment, and outcomes of patients with SJS/TEN managed by SAFIT, and to compare these measures according to whether the SAFIT consult occurred before or after burn unit admission.
Methods:
Retrospective case series of 15 consecutive patients with teledermatologist-confirmed SJS/TEN managed by SAFIT at a tertiary-care burn center. Clinical characteristics, treatment patterns, and patient outcomes were evaluated and compared based on the timing of teledermatology involvement relative to burn unit transfer. Time-to-biopsy after SAFIT consult was measured.
Results:
The cohort was 60.0% male with a mean age of 45.4 years. Mean SCORTEN was 1.6 ± 0.3, and mean body surface area involvement was 18.8 ± 5.9%. Biopsies were obtained in 93.3% of cases, with a mean time-to-biopsy of 2.5 ± 0.7 h after SAFIT consult. SAFIT initiated transfers to a burn center in 40.0% of cases, while 60.0% received their SAFIT consult after burn unit admission. There were no significant differences between groups in demographics, disease severity, treatment patterns, or clinical outcomes, including mortality, complications, and length of hospitalization. Mortality rates were consistent with expected ranges for SJS/TEN.
Conclusion:
When combined with burn unit care, SAFIT facilitates timely diagnosis and management of SJS/TEN, with comparable outcomes to prior literature regardless of consult timing. These findings suggest a role for SAFIT in standardizing and expanding access to dermatologic care. Future multicenter studies are warranted.