EXPRESSION OF CONCERN Firoz BF, Henning JS, Zarzabal LA, Pollock BH. Toxic epidermal necrolysis: Five years of treatment experience from a burn unit. J Am Acad Dermatol 2012;67:630-5. The Journal of the American Academy of Dermatology has been notified of possible data irregularities in a previously published article: Firoz BF, Henning JS, Zarzabal LA, Pollock BH. Toxic epidermal necrolysis: Five years of treatment experience from a burn unit. J Am Acad Dermatol 2012;67:630-5. As stated by the authors, this article details their experience treating 82 patients with a potentially fatal condition, toxic epidermal necrolysis (TEN), over a 5 year period at the burn unit of the Brooke Army Medical Center (BAMC) in San Antonio. All are said to have had a confirmatory biopsy. The complaint alleges 2 major discrepancies in the report: (1) The burn unit database indicates that no more than 48 patients with TEN were admitted there in any 5 year period in the last 9 years. (2) Only 75% of these had the diagnosis confirmed by biopsy. The Editor of the Journal of the American Academy of Dermatology and his staff have gone to great lengths to investigate this issue. The lead author has argued that the BAMC burn unit database is incorrect with regard to the number of TEN patients treated. She has stated that the published number of 82 is accurate because (a) some of the patients were incorrectly diagnosed initially by burn unit physicians and later found to have TEN, (b) they included in their report patients with TEN/Stevens-Johnson syndrome overlap (this was not specifically stated in the manuscript), and (c) some of the patients were treated using an ‘‘almost identical’’ protocol at Wilford Hall Medical Center (WHMC), an Air Force facility, rather than at BAMC; again, this was not specifically stated in the manuscript, which indicated that all patients were treated at the BAMC burn unit. The possible inaccuracies described above have prompted our ‘‘expression of concern’’ regarding this report.

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