Healing from Toxic Epidermal Necrolysis
Sesu Kekuoa is a third year radiography student at the University of Johannesburg. At the end of December 2013 she felt feverish and began to develop a rash all over her body. She was admitted to Leslie Williams Private Hospital in her hometown of Carletonville where she was diagnosed with Stephens Johnson Syndrome. A few days later this progressed to full blown Toxic Epidermal Necrolysis (TEN) - a rare, acute, serious, and potentially fatal skin reaction in which there is sheet-like skin and mucosal loss. It is nearly always caused by medications the patient is using.
Sesu was terrified at what was happening to her:
“I thought I looked like a monster! My skin started peeling off and I had blisters everywhere -even on my cheeks. They took away my phone so I couldn’t look at myself because then it would depress me. The last time I looked in the mirror I saw that my skin had peeled off that was the day that they sent me to ICU it was a very terrible day for me.”
Dr Emmanuel Kabuzi, the consulting specialist physician who managed Sesu’s care immediately isolated her and moved her to the intensive care unit. He explained that Toxic Epidermal Necrolysis is 'skin failure', in the same way we have kidney failure or heart failure. He needed to urgently identify which medication had trigged the extreme drug reaction and stop the use of it immediately as Toxic Epidermal Necrolysis carries a high mortality of up to 30%.
Dr Kabuzi had previously used Acticoat and Biobrane in the management of a severe case of TEN and so he called on Smith & Nephew to provide specialist assistance with wound management.
“We had a good working relationship with Smith & Nephew whom we have called before to nurse and dress and treat our patients with Stephens Johnson Syndrome and TEN complications. Appropriate and effective dressings are key in managing these cases and this is where it is important to work with a skilled team. When Smith and Nephew provided us with these specialised dressings in the past and they worked excellently. There is a lot of research that has gone into dressing with a lot of more modern materials, well researched and effective and the type of dressing really matters because it means you also use less sedation and pain killers. ”
Sesu described her pain like this:
“I felt like I had been poured with boiling water. That’s how I can explain it was like I was on fire. Even when someone would touch me like my family couldn’t even touch me anymore, they couldn’t hug me. I would cry because of the pain.”
When she returned for her follow up consult in March, Sesu radiated health and happiness. She said:
If I look back now at where I was two months ago, I’d say there’s hope for everyone out there who is suffering from TENs.
When I was in hospital and I looked at my face I thought I was going to be scarred for life but now the scars are disappearing and my face has healed. I would recommend this for other patients because I was told how the old treatment was. It was horrible because they would scrub you every day and that didn’t happen with me. There’s no evidence that I had TENs on my face and I know that can make a difference because I’m in the health profession and if I meet someone with TENs I can also tell them and encourage them about the Smith & Nephew management of this disease and they can see that I’m living proof that this does really help!