When individuals develop substantial skin necrosis, individual care is best provided in burn units or intensive care units before the detachment of blisters and necrotic skin occurs. A less logical and less clearly beneficial treatment is the surgical debridement of non-necrotic skin and the application of artificial dressings, as is practiced at some medical centers. In my opinion, it seems more logical to try to use naturally covering skin for as long as possible before relying on artificial or xerographic covering. Rather than removing the separated but still-covering skin, every effort should be made to limit trauma to this skin and preserve this natural covering. Debridement is most appropriate for detached skin that can no longer serve as a biological barrier or when infection is suspected in that area.
Treatments intended to halt the progression of skin detachment are more controversial.
Both common sense and the findings of Garcia-Doval et al suggest that for such active measures to have any chance of success, they must be used early in the course of the disease. Given that full skin involvement in these conditions typically occurs within 4 days or less, agents meant to halt disease progression and decrease the extent of skin detachment are unlikely to have substantial effect if used more than a few days after disease onset. Of the various treatments advocated to modify the extent of skin detachment, the one that remains the most controversial is the use of systemic steroids. The literature also suggests that a variety of other agents and therapies may successfully treat TEN and SJS, including plasmapheresis and immunosuppressive therapy. In my opinion, scientific data that support a substantial clinical benefit for plasmapheresis and most immunosuppressive treatments are at best weak.