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Amniotic membranes rapidly reverse skin detachment caused by epidermal necrolysis
NEW YORK (Reuters Health) - In a case report of a woman with lamotrigine-induced toxic epidermal necrolysis (TEN), placement of amniotic membranes over areas of epidermal detachment led to complete re-epithelialization within 5 days.
Reporting in the June issue of the Archives of Dermatology, physicians in Chile describe the case of a 36-year-old woman with depressive disorder prescribed lamotrigine at a starting dose of 25 mg/day, following by upward dose titration of 25 mg/wk....
NEW YORK (Reuters Health) - In a case report of a woman with lamotrigine-induced toxic epidermal necrolysis (TEN), placement of amniotic membranes over areas of epidermal detachment led to complete re-epithelialization within 5 days.
Reporting in the June issue of the Archives of Dermatology, physicians in Chile describe the case of a 36-year-old woman with depressive disorder prescribed lamotrigine at a starting dose of 25 mg/day, following by upward dose titration of 25 mg/wk. Upon reaching a dose of 75 mg/d, she presented with an acute abdominal skin eruption, which progressed over the next day to bullous eruptions with epidermal detachment affecting nearly half of the body surface area.
Her condition failed to respond to 5 days' treatment with intravenous immunoglobulin (IVIG) 1 g/kg/d, Dr. Rodrigo Schwartz, at the University of Chile in Santiago, and his colleagues report.
Twenty-four hours after amniotic membranes were applied, the authors observed a "dramatic improvement." The woman experienced "a marked decrease in exudation from denuded areas and control of her pain." After 5 days, complete reepithelialization had occurred.
They attribute these effects to the presence of growth factors and anti-inflammatory mediators in amniotic cells, as well as the physical barrier against excess fluid and protein loss and protection from external biological and physical injury.
Dr. Schwartz and his colleagues conclude that "amniotic membranes in association with IVIG may prove to be effective coadjuvant treatments in the treatment of TEN."
Arch Dermatol 2008;144:724-726.
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