Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: an international, multidisciplinary Delphi-based consensus

. 2021 Sep ; 185 (3) : 616-626. [epub] 20210427

Jazyk angličtina Země Velká Británie, Anglie Médium print-electronic

Typ dokumentu časopisecké články, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/pmid33657677

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.

1st Dermatology Division Institute Dermopatico dell'Immacolata IRCCS Via Monti di Creta 104 Rome 00167 Italy

Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA

Birmingham Children's Hospital and University of Birmingham Birmingham UK

Burn Surgery Service Shriners Burns Hospital Sumner Redstone Burn Center Massachusetts General Hospital Harvard Medical School Boston MA USA

Christine Kühne Center for Allergy Research and Education Davos Switzerland

Clinical Experimental Sciences Faculty of Medicine University of Southampton Southampton UK

Clinical Institute University of Southern Denmark Department of Clinical Genetics Odense University Hospital Odense Denmark

Department of Dermatology 2 Colentina Clinical Hospital Carol Davila University of Medicine and Pharmacy Bucharest Romania

Department of Dermatology Aarhus University Hospital Palle Juul Jensens Aarhus Denmark

Department of Dermatology and Allergology University Hospital Salzburg of the Paracelsus Medical University Salzburg Salzburg Austria

Department of Dermatology and Allergy University Hospital of Munich LMU Munich Germany

Department of Dermatology and Cutaneous Surgery Miller School of Medicine University of Miami Miami FL USA

Department of Dermatology AP HP Necker Hospital Paris France

Department of Dermatology Brigham and Women's Hospital Harvard Medical School Boston MA USA

Department of Dermatology Center for Blistering Diseases University Medical Center Groningen University of Groningen Groningen the Netherlands

Department of Dermatology CHU Bordeaux Bordeaux France

Department of Dermatology CHU Charles Nicolle Rouen France

Department of Dermatology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA

Department of Dermatology Drug Hypersensitivity Clinical and Research Center Chang Gung Memorial Hospital Taoyuan Taiwan

Department of Dermatology King's College Hospital London UK

Department of Dermatology Kyorin University School of Medicine Tokyo Japan

Department of Dermatology Leiden University Medical Center Leiden the Netherlands

Department of Dermatology National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan

Department of Dermatology Perelman School of Medicine University of Pennsylvania Philadelphia PA USA

Department of Dermatology University Hospital Zurich Zurich Switzerland

Department of Dermatology University of California Davis Sacramento CA USA

Department of Dermatology University of California San Francisco CA USA

Department of Dermatology University of South Florida Cutaneous Oncology Program Moffitt Cancer Center Tampa FL USA

Department of Dermatovenereology St Ann's University Hospital Faculty of Medicine Masaryk University Brno Czech Republic

Department of Medicine and Pharmacology Vanderbilt University Medical Center Nashville TN USA

Department of Otorhinolaryngology and Head and Neck Surgery AP HP Henri Mondor Hospital Créteil France

Department of Paediatric Dermatology Colentina Clinical Hospital Carol Davila University of Medicine and Pharmacy Bucharest Romania

Department of Psychiatry AP HP Henri Mondor Albert Chenevier Hospitals Cr France

Department of Skin and Allergic Diseases University of Helsinki and Helsinki University Central Hospital Helsinki Finland

Departments of Dermatology and Pediatrics Northwestern University Feinberg School of Medicine Chicago IL USA

Dermatology Department AP HP Henri Mondor Hospital Créteil France

Division of Clinical Pharmacology and Toxicology University of Toronto Toronto ON Canada

Division of Dermatology Department of Internal Medicine Ohio State University Columbus OH USA

Division of Dermatology Sunnybrook Health Sciences Centre Toronto ON Canada

Faculty of Medicine University of Zurich Zurich Switzerland

Intensive Care Unit AP HP Henri Mondor Hospital Créteil France

Keck USC School of Medicine Los Angeles CA USA

Macmillan Skin Cancer CNS Normanby Building Denmark Hill London UK

Massachusetts General Hospital Harvard Medical School Boston MA USA

Niigata University Graduate School of Medical and Dental Sciences Niigata Japan

Ophthalmology Department Hospital Charles Nicolle EA7510 UFR Santé Rouen University Rouen France

Queen Elizabeth Hospital Birmingham University Hospital Birmingham NHS Foundation Trust Birmingham UK

Réanimation Chirurgicale et des Brûlés PTMC CHU Nantes Nantes France

Science 37 Los Angeles CA USA

Toxic Bullous Dermatoses TOXIBUL Reference Centre Filière FIMARAD AP HP Henri Mondor Hospital Créteil France

ToxiTEN Group European Reference Network for Rare Skin Diseases Paris France

Universit EpiDermE Créteil France

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