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Figure 6. Example of Toxic Epidermal Necrolysis. Image author Afro Brazilian. Obtained with permission under Creative Commons license
Attribution-Share Alike 3.0 Unported. https://creativecommons.org/licenses/by-sa/3.0/deed.en

Treatment
Treatment involves a multidiscipline approach. The TKI must be stopped and the patient should be
transferred to the intensive care unit or burn unit. Supportive care measures involve thermoregulation with
an ambient temperature of 28-32 degrees Celsius. If a respiratory compromise is suspected, these patients
can be intubated. Administration of fluid replacement is advised at 0.7 mL/kg/(% affected area) along with
a 5% albumin solution at 1 mL/kg/(% affected area) [46,47] . Systemic corticosteroids are the most common
treatment for SJS/TEN, a suggested protocol is intravenous dexamethasone at 1.5 mg/kg pulse therapy
(given for 30-60 min) for 3 consecutive days [46,48] . Cyclosporine and Etanercept have also shown benefit [49,50] .
Daily skin treatment is recommended with a daily antiseptic bath containing a solution of chlorhexidine
1/5000 or with a chlorhexidine spray. Skin debridement should be avoided because necrolytic sheets act as
a natural biological dressing. Nonadhesive dressings are used to cover pressure points [49,50] [Figure 6].

TYROSINE KINASE INHIBITORS USED FOR HCC TREATMENT
Tyrosine kinase inhibitors, including Sorafenib, Lenvatinib, Cabozantinib, and Regorafenib are small
molecules that attack cancers by inhibiting the activity of receptor tyrosine kinases which are responsible
[51]
for tumor-promoting pathways such as proliferation and angiogenesis .