(P24-004-25) Augmented Healing in the Case of Toxic Epidermal Necrolysis in a Preadolescent by Zinc Supplementation

Objectives: Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous reaction, often drug induced, marked by keratinocyte apoptosis, epidermal sloughing, mucosal erosions, and systemic involvement. With a 30% mortality rate, TEN is associated with significant long term morbidity.

Zinc, an essential micronutrient, important for growth, development and immune function is cofactor for over 3000 proteins, contributing to DNA repair, transcription regulation, apoptosis, and antioxidant defence. Zinc, concentrated in the epidermis, constitutes about 5% of the body's total zinc. Its deficiency affects collagen synthesis and degradation.

Methods: A 7 year old male presented with fever and cough for 7 days. He was treated on out patient basis by Syrup Cefpodoxime for 3 days at a local hospital, but he gradually developed swelling of eyes associated with purulent discharge and conjunctival congestion. Upon admission to JSS Hospital, he exhibited multiple vesicular lesions — ill defined dusky erythematous plaques present all over the body, maximum at trunk, back and in the genital area. He had oral bleeding, swelling, erythema, crusting and desquamation over lips. He also developed a cough with whitish sputum and hurried breathing.

Results: Child was given ICU care, maintenance fluids and oxygen support for respiratory distress. Injection hydrocortisone given for 48 hours and Salbutamol nebulisations were started. Oral cyclosporine was started along with a topical antibiotic. He was started on oral zinc supplementation (20mg/kg/day BD) for 1 month.

The child showed clinical improvement without new lesions, and blood tests improved with sterile cultures 72 hours after starting the treatment and zinc therapy. The child was discharged with no new lesions observed after 1 month.

Conclusions: TEN, being a disease characterised by severe epidermal sloughing, Zinc augments its wound healing process, particularly by epithelialization, where its therapeutic benefits are most prominent. It promotes collagen synthesis, enhancing the tensile strength of partially healed cutaneous wounds.

Documented use of supplemental zinc therapy in critically ill patients, burns, minor surgeries, abscesses, and pressure ulcers highlights its role in cutaneous wound healing. This case demonstrates enhanced healing with zinc therapy in a child with TEN.

Funding Sources: None