Toxic Epidermal Necrolysis
Conditions
Brief summary
The primary objectives of this study are to investigate the efficacy and safety of topical steroid ointment (clobetasol 0.05%) for the treatment of the cutaneous manifestations of toxic epidermal necrolysis (TEN).
Detailed description
The experimental focus of this trial is thus to evaluate the safety and clinical outcomes of topical steroid (clobetasol 0.05% ointment) for treatment of the cutaneous manifestations of toxic epidermal necrolysis (TEN). The design of the study is a randomized, placebo-controlled, double-blind split-body Phase II clinical trial in which clobetasol 0.05% or placebo ointment will be topically applied to opposite arms for a period of fourteen days. The primary endpoints of the study are to determine the time to cessation of skin detachment in both groups as well as the safety of topical clobetasol to treat the cutaneous manifestations of TEN. Secondary outcome measures will evaluate efficacy by comparing the time to re-epithelialization and the percentage of affected skin between the clobetasol and placebo arms at various time points. An additional aim of the study is to characterize the genes expressed during the TEN disease state and any changes in gene expression following treatment with topical steroids, particularly those genes involved in the regulation of programmed cell death (apoptosis). This will be accomplished though molecular analysis of skin biopsy specimens obtained after treatment with clobetasol and placebo ointments. The specific hypothesis being tested is that two weeks of topical clobetasol will promote epidermal keratinocyte survival through suppression of TNF signaling, decreased granulysin expression and inhibition of other pro-apoptotic pathways resulting in shorter disease duration and decreased time to re-epithelialization. IRB number: 642415-5
Interventions
Blinded, daily application to one arm for a period of fourteen (14) days
DRUGPlacebo
Blinded, daily application to one arm for a period of fourteen (14) days
Sponsors
University of California, Davis
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
7 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Characteristic histological findings on diagnostic biopsy * Clinical diagnosis verified by two independent physicians * Greater than 10% affected body surface area (BSA) * Ability to start treatment within seven days or less from the onset of erosions * Actively worsening disease (enlarging area of involvement or new erosions occurring over the last 24 hours) * Patient Body Surface Area (BSA) \> 1.0 m2 * Reproductive age female patients must have a negative pregnancy test prior to enrollment
Exclusion criteria
* Patients will be excluded if they are \< 7 or \> 85 years of age. * Patients who have documented: * Uncontrolled infection (e.g. documented bacteremia) * Malignancy * Known prior immunodeficiency * Pregnancy * Concurrent use of systemic corticosteroids in the burn center greater than or equal to 0.5 mg/kg/day of prednisone or equivalent dose of similar medication. * Greater than 70% eroded skin * SCORETEN score \>3 on hospital admission * Patients will also be excluded if they have: active hepatitis and/or an ALT or AST greater than four times the normal limits, or renal insufficiency with an estimated GFR\<50 mL/min/1.73m2.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Safety (numeric cellulitis score) | 14 days | Local infection (cellulitis) is a potential complication of treatment with topical steroid ointment. A primary outcome measure of the study will be to determine if any difference in local infection rate exists between between control and clobetasol-treated skin in patients with toxic epidermal necrolysis, determined by daily assessments and assignment of a numeric cellulitis score. |
| Time to Cessation of Skin Detachment | 14 days | The time until cessation of skin detachment (measured in days) will be determined though daily skin examinations and compared between the clobetasol and placebo-treated skin of patients with toxic epidermal necrolysis. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to 90% re-epithelialization | 14 days | The time to 90% re-epithelialization will be determined by daily skin examinations and recorded in days to determine if a significant difference exists between control and clobetasol treated skin. |
| Percent Affected Surface Area | 14 days | Percent affected surface area will be measured with daily skin examinations and compared between the placebo and steroid treated skin in patients with TEN |
| Percent Affected Surface Area Detached Skin | 14 days | The percent body surface area affected by detached skin will be monitored through daily skin examinations and compared between the clobetasol and placebo treated skin in patients with toxic epidermal necrolysis. |
Countries
United States
Outcome results
None listed