30th July 2026

Medical management

The mainstay of treatment is aimed at adequate wound management to maintain the skin barrier and reduce fluid loss.

Other steps in management include: 

• Stop suspected causative agent 
• VTE prophylaxis 
• Adequate analgesia using validated pain scores/tools
• Wound management 
  • Strict barrier nursing to reduce infection risk  
  • Wound swabs from three areas regularly throughout the acute phase of infection 
  • Wound cleansing with saline +/- antimicrobial such as chlorhexidine 
  • Emollient use over all epidermis 
  • Topical anti-microbial to sloughy areas 
  • Decompression of blisters either by piercing or aspiration of fluid 
• Transfer to burns unit if >30% of BSA affected and:
  • Clinical deterioration
  • Extension of epidermal detachment 
  • Sub-epidermal pus
  • Local sepsis 
  • Wound conversion 
  • Delayed healing 
• Surgical management 
  • Removal of necrotic tissue and cleaning under general anaesthetic 
  • Surgical debridement of wounds
  • Closure of wounds using allograft/xenograft of biobrane 

• Fluid management 

• Fluid input/output
• Replacement as appropriate 

• Nutrition
  • Continuous enteral nutrition of 20-25kcal/kg/day in the acute phase and 25-30kcal/kg/day in the recovery phase 
• Ocular involvement 
  • Ophthalmologic review 
  • Ocular hydration drops +/- topical corticosteroid drops 
  • Prophylactic topical antibiotic 
• Urogenital involvement 
  • Daily urogenital review
  • Wound management with white soft paraffin ointment 
  • Urinary catheter 
• Mouth involvement 
  • Wound management with white soft paraffin ointment 
  • Anti-inflammatory +/- steroid mouthwash 
• Daily saline mouthwash 
• Airway involvement 
  • Transfer to ICU/burn unit
  • Fibre-optic bronchoscopy if there is respiratory involvement