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Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: an international, multidisciplinary Delphi-based consensus.
Brüggen, M-C; Le, S T; Walsh, S; Toussi, A; de Prost, N; Ranki, A; Didona, B; Colin, A; Horváth, B; Brezinova, E; Milpied, B; Moss, C; Bodemer, C; Meyersburg, D; Salavastru, C; Tiplica, G-S; Howard, E; Bequignon, E; Bouwes Bavinck, J N; Newman, J; Gueudry, J; Nägeli, M; Zaghbib, K; Pallesen, K; Bygum, A; Joly, P; Wolkenstein, P; Chua, S-L; Le Floch, R; Shear, N H; Chu, C-Y; Hama, N; Abe, R; Chung, W-H; Shiohara, T; Ardern-Jones, M; Romanelli, P; Phillips, E J; Stern, R S; Cotliar, J; Micheletti, R G; Brassard, A; Schulz, J T; Dodiuk-Gad, R P; Dominguez, A R; Paller, A S; Seminario-Vidal, L; Mostaghimi, A; Noe, M H; Worswick, S.
Affiliation
  • Brüggen MC; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
  • Le ST; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
  • Walsh S; Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.
  • Toussi A; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • de Prost N; Department of Dermatology, University of California, Davis, Sacramento, CA, USA.
  • Ranki A; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Didona B; Department of Dermatology, King's College Hospital, London, UK.
  • Colin A; Department of Dermatology, University of California, Davis, Sacramento, CA, USA.
  • Horváth B; Intensive Care Unit, AP-HP, Henri Mondor Hospital, Créteil, France.
  • Brezinova E; Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.
  • Milpied B; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Moss C; Department of Skin and Allergic Diseases, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
  • Bodemer C; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Meyersburg D; First Dermatology Division, Institute Dermopatico dell'Immacolata (I.D.I.) - IRCCS, Via Monti di Creta 104, Rome, 00167, Italy.
  • Salavastru C; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Tiplica GS; Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.
  • Howard E; Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.
  • Bequignon E; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Bouwes Bavinck JN; Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
  • Newman J; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Gueudry J; Department of Dermatovenereology, St Ann's University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
  • Nägeli M; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Zaghbib K; Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.
  • Pallesen K; Department of Dermatology, CHU Bordeaux, Bordeaux, France.
  • Bygum A; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Joly P; Birmingham Children's Hospital and University of Birmingham, Birmingham, UK.
  • Wolkenstein P; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Chua SL; Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.
  • Le Floch R; Department of Dermatology, AP-HP, Necker Hospital, Paris, France.
  • Shear NH; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Chu CY; Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University Salzburg, Salzburg, Austria.
  • Hama N; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Abe R; Department of Paediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
  • Chung WH; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Shiohara T; Department of Dermatology II, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
  • Ardern-Jones M; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Romanelli P; Birmingham Children's Hospital and University of Birmingham, Birmingham, UK.
  • Phillips EJ; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Stern RS; Department of Otorhinolaryngology and Head and Neck Surgery, AP-HP, Henri Mondor Hospital, Créteil, France.
  • Cotliar J; Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands.
  • Micheletti RG; Macmillan Skin Cancer CNS, Normanby Building, Denmark Hill, London, UK.
  • Brassard A; Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.
  • Schulz JT; Ophthalmology Department, Hospital Charles Nicolle, EA7510, UFR Santé, Rouen University, Rouen, France.
  • Dodiuk-Gad RP; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
  • Dominguez AR; Toxic Bullous Dermatoses TOXIBUL Reference Centre, Filière FIMARAD, AP-HP, Henri Mondor Hospital, Créteil, France.
  • Paller AS; Department of Psychiatry, AP-HP, Henri Mondor-Albert Chenevier Hospitals, Cr, France.
  • Seminario-Vidal L; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Mostaghimi A; Department of Dermatology, Aarhus University Hospital, Palle Juul-Jensens, Aarhus, Denmark.
  • Noe MH; ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-skin), Paris, France.
  • Worswick S; Clinical Institute, University of Southern Denmark, Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.
Br J Dermatol ; 185(3): 616-626, 2021 09.
Article in En | MEDLINE | ID: mdl-33657677
ABSTRACT

BACKGROUND:

Supportive care is the cornerstone of management of adult and paediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities of supportive care is lacking.

OBJECTIVES:

Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN.

METHODS:

Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method.

RESULTS:

Forty-five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements.

CONCLUSIONS:

We have reached an international Delphi-based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short-term prognosis and the risk of sequelae.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Stevens-Johnson Syndrome Type of study: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies / Qualitative_research Limits: Adult / Child / Humans Language: En Journal: Br J Dermatol Year: 2021 Document type: Article
Fulltext
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Stevens-Johnson Syndrome Type of study: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies / Qualitative_research Limits: Adult / Child / Humans Language: En Journal: Br J Dermatol Year: 2021 Document type: Article