摘要：Toxic epidermal necrolysis (TEN) is a rare condition that was described by Lyell in 1956. It is a severe, acute, adverse, primarily drug-induced, potentially fatal, cutaneous reaction that is characterized by large areas of skin desquamation and sloughing, similar in many aspects to second-degree burns. The treatment of cutaneous drug reactions rests essentially on immediate diagnosis and recognition of the disease process, accurate history, thorough physical examination, prompt discontinuation of the offending drug, and supportive care. TEN patients are best managed in specialized burn units. Nevertheless, the management remains very much individualized, based on the clinical setting. Topical wound care remains an essential factor in the treatment of burn-like syndromes and is a main determining parameter for morbidity and mortality. As the value of moist environment in wound healing is being fully appreciated, we report on the use of a newly introduced ointment, the Moist Exposed Burn Ointment (Julphar; Gulf Pharmaceutical industries, Ras El-Khaymah, United Arab of Emirutes), a moisture-retentive ointment, in the successful management of a case of TEN.

摘要：Improved healing of full- and partial-thickness cutaneous wounds in wet and moist environments is due primarily to retention of biological fluids over the wound preventing desiccation of denuded dermis or deeper tissues. This also allows faster and unimpeded migration of keratinocytes over the wound surface and enables the naturally occurring cytokines and growth factors to exert their beneficial effect on wound contracture and reepithelialization. Despite all these documented benefits creating and maintaining a sealed moist environment over large surface areas such as large skin graft donor sites or extensive burns is technically difficult if not impossible. The preliminary investigation carried out between 1999 and 2000 studied the healing of a split-thickness skin graft (STSG) following application of moist exposed burn ointment (MEBO). This compound provides a moist environment without the need of an overlying occlusive dressing, and compares favorably with Sofra-Tulle semi-open dressing. Healing of STSG donor sites was then evaluated from January to September 2001 in a prospective study comparing the effect of Tegaderm, a semipermeable membrane occlusive dressing, and MEBO, two different types of moist dressings. Wound healing was evaluated by measuring transepidermal water loss (TEWL), and scar quality was assessed by two independent observers using a visual analogue scale. Faster healing was observed clinically with MEBO application. Physiological healing as determined by TEWL measurements occurred at an extremely significant earlier stage for MEBO, and this was associated with better scar quality demonstrating a positive relationship between function and cosmetic appearance. Moreover, simple ointment application was definitely more practical than application of the occlusive self-adhesive membrane.

摘要：BACKGROUND? There is growing evidence of improved healing of full- and partial-thickness cutaneous wounds in wet and moist environments. Retention of biologic fluids over the wound prevents desiccation of denuded dermis or deeper tissues and allows faster and unimpeded migration of keratinocytes over the wound surface. It allows also the naturally occurring cytokines and growth factors to exert their beneficial effect on wound contracture and re-epithelialization. Despite all of these documented benefits, applying the moist healing principles to large surface areas, in particular to large burns, is hindered by the major technical handicap of creating and maintaining a sealed moist environment over these areas. METHODS? From January to September 2001, healing of partial-thickness skin graft donor sites was studied in a prospective comparative study of two types of moist dressings, Tegaderm (3M Health Care, St. Paul, MN), a semipermeable membrane occlusive dressing, and moist exposed burn ointment (MEBO) (Julphar; Gulf Pharmaceutical Industries, United Arab of Emirates), an ointment that can provide a moist environment without the need of an overlying occlusive dressing. Healing was assessed both clinically and with serial measurements of transepidermal water loss (TEWL) and moisture. Following healing, scar quality was evaluated by two members of the team separately using a visual analog scale. Results were statistically analyzed. RESULTS? Faster healing was observed clinically with MEBO application. Physiologic healing as determined by TEWL measurements occurred at an extremely significant earlier stage for MEBO, and this was associated with better scar quality, demonstrating a positive relationship between function and cosmetic appearance. Moreover, the ointment is definitely easier to apply than the occlusive self-adhesive membrane, which requires some degree of dexterity and expertise. CONCLUSION? MEBO application is an effective and valid alternative to conventional occlusive dressings. Moreover, the observed improved anatomic and physiologic healing indicates that MEBO may have a positive effect on healing more that the mere fact of passive moisture retention.

摘要：Moist exposed burn therapy is a therapeutic principle based on the moist environment of the wound, using an ointment of herbal origin that enhances epithelial repair. This is the ca se of a 42-year-old female who sustained partial thickness burn wounds on her face and upper extremities. Patient was started on wound dressing with β-sitosterol and berberine moist exposed burn ointment (MEBO) and noted the formation of erythematous verrucous plaques overlying the burned areas after four weeks. Histopathological examination of the lesions revealed papillomatosis, acanthosis, and hyperkeratosis. The lesions resolved upon discontinuation of MEBO and application of a combination of topical steroid, keratolytic, and emollient. The reactive epidermal hyperplasia seen in the case presented may have been due to increased levels of basic fibroblast growth factor in burn wounds treated with MEBO. Careful instructions and close monitoring of patients applying the ointment must be reinforced due to the possibility of react ive inflammatory skin reactions.