Abstract：
Toxic epidermal necrolysis (TEN) involves extensive mucocutaneous loss, and care is supportive. The approach to wound care includes surgical debridement or using dressings while leaving the epidermis intact. Robust evidence for either approach is lacking. We compared surgical debridement to the use of dressings while leaving the epidermis in situ (referred to hereon as dressings) in adult patients with TEN. The primary outcome assessed was mortality. The secondary outcome was time to re-epithelialisation. The impact of medications was evaluated. An individual patient data (IPD) systematic review and meta-analysis was undertaken. A random effects meta-analysis and survival analysis for IPD data examined mortality, re-epithelisation time and the effect of systemic medications. The quality of evidence was rated per the Grading of Recommendations Assessment, Development and Evaluation (GRADE). PROSPERO: CRD42021266611 Fifty-four studies involving 227 patients were included in the systematic review and meta-analysis, with a GRADE from very low to moderate. There was no difference in survival in patients who had surgical debridement or dressings (univariate: p = 0.91, multivariate: p = 0.31). Patients who received dressings re-epithelialised faster than patients who underwent debridement (multivariate HR: 1.96 [1.09-3.51], p = 0.023). Intravenous immunoglobulin (univariate HR: 0.21 [0.09-0.45], p < 0.001; multivariate HR: 0.22 [0.09-0.53], p < 0.001) and cyclosporin significantly reduced mortality (univariate HR: 0.09 [0.01-0.96], p = 0.046; multivariate HR: 0.06 [0.01-0.73], p = 0.028) irrespective of the wound care. This study supports the expert consensus of the dermatology hospitalists, that wound care in patients with TEN should be supportive with the epidermis left intact and supported with dressings, which leads to faster re-epithelialisation.
摘要：
毒性表皮坏死松解症（TEN）涉及广泛的粘膜皮肤损失，护理是支持性的。伤口护理的方法包括手术清创或使用敷料，同时保持表皮完整。缺乏任何一种方法的有力证据。我们比较了TEN成年患者的手术清创术和使用敷料，同时将表皮留在原位（在此称为敷料）。评估的主要结果是死亡率。次要结果是重新上皮化的时间。评估药物的影响。进行了个体患者数据（IPD）系统评价和荟萃分析。对IPD数据的随机效应荟萃分析和生存分析检查了死亡率，上皮再形成时间和全身药物的效果。根据建议评估等级对证据质量进行评级，开发和评估（等级）。PROSPERO：CRD4202126661154项研究纳入系统评价和荟萃分析，涉及227例患者。等级从非常低到中等。手术清创术或敷料的患者的生存率没有差异（单变量：p=0.91，多变量：p=0.31）。接受敷料的患者比接受清创的患者的上皮再生更快（多变量HR：1.96[1.09-3.51]，p=0.023)。静脉免疫球蛋白（单变量HR：0.21[0.09-0.45]，p<0.001；多变量HR：0.22[0.09-0.53]，p<0.001）和环孢菌素显着降低死亡率（单变量HR：0.09[0.01-0.96]，p=0.046；多变量HR：0.06[0.01-0.73]，p=0.028），与伤口护理无关。这项研究支持皮肤科医院的专家共识，TEN患者的伤口护理应支持表皮保持完整并用敷料支撑，这导致更快的再上皮化。
