article · Nigerian Postgraduate Medical Journal
Toxic epidermal necrolysis is a severe, life-threatening skin condition triggered by medication hypersensitivity, resulting in extensive blistering and peeling of the skin and mucous membranes. Standard care requires non-adherent dressings, but commercial pre-packaged options are often costly or unavailable in low-resource environments. This case report details the successful treatment of a two-year-old girl who developed widespread exfoliation covering more than seventy percent of her body. Alongside intensive paediatric supportive care, fluid management, and antibiotics, the hospital managed her extensive wounds using locally prepared dressings. Staff created non-adherent dressings by impregnating gauze with petroleum jelly and sterilising it within the hospital central sterilising services department. Daily saline cleaning and application of these low-cost dressings enabled complete wound healing, allowing the patient to be discharged after six weeks of inpatient care.
Severe skin-detaching disorders require sterile, non-stick dressings to prevent fluid loss and lethal infections. When expensive commercial wound care products are unavailable, demonstrated alternatives using simple, locally assembled, and hospital-sterilised materials can save lives. This practical approach provides healthcare providers in resource-limited settings with a viable, low-cost protocol to treat critical dermatological emergencies without compromising patient outcomes.
This work demonstrates an applied, hospital-level protocol rather than a commercial product. The method uses existing hospital sterilisation departments and readily available commodities, such as gauze and petroleum jelly, to substitute for expensive commercial dressings. The primary users are clinical teams and hospital pharmacies in low-resource settings seeking affordable, immediately deployable wound-care alternatives, though further commercial product translation is not indicated in the abstract.
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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.
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DOI: 10.4103/npmj.npmj_121_26
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