A review of the use of nanocrystalline silver dressings as part of a regiment to treat Necrotizing fasciitis, Stevens–Johnson Syndrome & Toxic Epidermal Necrolysis

Wound Bed Preparation (WBP) can be described as the management of the wound to accelerate endogenous healing or to facilitate the effectiveness of other therapeutic measures. The 4 basic aspects of WBP can now be represented by an acronym, TIME T= tissue (non-viable or deficient), addressed clinically via debridement.  I= infection or inflammation, addressed clinically via antimicrobial agents.  M= moisture control, addressed clinically via absorbent dressings and/or compression.  E= epidermal margin, addressed clinically via tissue engineered constructs/grafts. WBP is also an appropriate approach when considering treatment of the wounds caused by Necrotizing Fasciitis (NF), Stevens-Johnson Syndrome (SJS) & Toxic Epidermal Necrolysis (TEN). Focusing on the “I” in TIME, there are numerous antimicrobial dressings that are intended to fulfill this need including silver based dressings. NF, commonly known as flesh-eating disease or flesh-eating bacteria, is a rare infection of the deeper layers of skin and subcutaneous tissues, easily spreading across the fascial plane within the subcutaneous tissue. SJS is a life-threatening condition affecting the skin in which cell death causes the epidermis to separate from the dermis. TEN, also known as Lyell's syndrome, is a life-threatening dermatological condition that is frequently induced by a reaction to medications.[1] It is characterized by the detachment of the top layer of skin (the epidermis) from the lower layers of the skin (the dermis) all over the body.  There is broad agreement in medical literature that TEN can be considered a more severe form of Stevens-Johnson syndrome. The aim of this review is to discuss the cause, treatment, and cost & investigate what role nanocrystalline silver may play in the treatment of these conditions. From the clinical literature it appears that nanocrystalline silver may be a viable tool in controlling bacterial burden during the treatment of these 3 conditions.