Bairbre Wynne
St James's Hospital, Ireland
Abstract Title:
A multidisciplinary approach for Toxic Epidermal Necrolysis: Integrating etanercept, hydrosurgery, biobrane, and amniotic membrane transplantation
Biography:
Dr Bairbre Wynne is a Consultant Dermatologist and Head of the Department of Dermatology at St James's Hospital, Dublin, Ireland. She is also a Clinical Senior Lecturer in the School of Medicine at Trinity College Dublin (TCD). A graduate of the Royal College of Surgeons in Ireland, Dr Wynne has special subspecialty interests in severe cutaneous adverse drug reactions and connective tissue diseases. She founded and leads the multi-disciplinary Lupus Clinic at St James's Hospital. Dedicated to academic excellence, her clinical work focuses on developing innovative, multidisciplinary clinical protocols for managing dermatological emergencies.
Research Interests:
Background: Toxic Epidermal Necrolysis (TEN) is a rare, life-threatening mucocutaneous reaction with high mortality. Traditional management has relied on broad systemic immunosuppression and conservative wound care. This abstract outlines our department's innovative, protocol-driven approach combining targeted systemic immunomodulation with advanced surgical and mucosal interventions to optimize patient survival and outcomes.
Methods: We evaluated our standardized departmental protocol for patients presenting with severe TEN (>30% total body surface area involvement). Systemic progression was halted using subcutaneous Etanercept (TNF-α inhibitor). Cutaneous wound beds were prepared using the Versajet hydrosurgery system for selective, precise debridement of non-viable tissue. Denuded areas were immediately covered with Biobrane biosynthetic skin substitutes. Concurrently, acute ocular mucosal involvement was managed via early ophthalmic amniotic membrane transplantation (AMT).
Results: Etanercept administration rapidly halted further epidermal detachment without the volume-overload risks of traditional therapies. Versajet hydrosurgery allowed for ultra-conservative debridement, creating a clean, uniform wound bed with minimal mechanical trauma or blood loss. Immediate application of Biobrane provided excellent adherence, resulting in immediate pain reduction, robust fluid/protein barrier control, and significantly lower systemic sepsis rates. Early ocular AMT successfully suppressed local cicatricial inflammation, actively preventing symblepharon formation and long-term corneal scarring. This combined multi-modal protocol dramatically accelerated cutaneous re-epithelialization and reduced intensive care unit (ICU) length of stay.
Conclusion: Our department's protocol demonstrates that combining targeted systemic biologics with precise hydrosurgical debridement and advanced bio-coatings represents a shift in TEN management. By addressing systemic inflammation, cutaneous barrier loss, and mucosal loss, this comprehensive approach minimizes morbidity and improves survival in severe dermatological emergencies.
