We read with interest the article by Shammas and associates, which described the usefulness of the application of amniotic membrane graft along with intensive topical steroids in cases of acute toxic epidermal necrolysis/Stevens Johnson syndrome. This report addresses the issue of management of acute toxic epidermal necrolysis/Stevens Johnson syndrome, for which there is no standardized management protocol in literature. We offer a few comments.
The results of this study are in agreement with recently published reports, and this case series demonstrates that amniotic membrane graft performed in the acute phase of toxic epidermal necrolysis/Stevens Johnson syndrome is vital to prevent sight-threatening cicatricial complications as the disease progresses.
These authors have not mentioned the details of systemic treatment. As noted by Araki and associates, use of systemic pulse corticosteroids during the early period of 1 to 2 weeks has a beneficial effect. So if corticosteroids were used, the effect of amniotic membrane graft may be masked.
It is not clear whether all the patients were consecutive or if there were other methods of management. If other methods were present, a comparison between the different treatment groups would have validated the authors’ point further.
The authors should have mentioned the time elapsed between application and removal of the ProKera device (Bio-Tissue, Inc., Miami, Florida, USA), thus providing a guideline for practitioners.