531 Sex-based Differences in the Skin: Is It Just a Female Problem?

Abstract Introduction Female gender is associated with poorer outcomes in burns, not necessarily related to co-morbid conditions. Our objective was to analyze the effect of gender in biopsy proven Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN) spectrum disorders at our institution. Methods Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. All patients admitted with biopsy proven SJS, SJS/TEN overlap, and TEN between January 1, 2009 and December 31, 2018 were eligible for inclusion. Demographics, length of stay, and mortality were evaluated. Statistical analysis was performed with Students’ t-test, chi-squared, and Fischer’s exact test. Results One hundred and sixty-eight patients had biopsy proven SJS, SJS/TEN overlap, or TEN. Sixty-one percent of patients were female. The average age of female patients was 51 years while the average age of male patients was 44 years, p< 0.05. Fifty-sex percent of female patients were black. All American Indian patients were female. Female patients had significantly longer lengths of stay, 34 days versus 22 days, p< 0.05. Female patients had an average SCORTEN (a severity of illness score of TEN) compared to male patients. Thirty-three percent of female patients died compared to 18% of male patients, p< 0.05. Two out of three American Indian patients in this cohort died. Conclusions Female gender is associated with increased mortality in burn patients, as well as in our cohort of patients with SJS/TEN. Females represent 51% of our state’s population, but 61% of patients with biopsy proven SJS, SJS/TEN overlap, and TEN at our institution. Compared to male patients, female patients presented with more severe disease (higher SCORTEN at presentation). Genomic, and proteomic studies looking at sex-based differences may be helpful in elucidating the origin of these differences. Applicability of Research to Practice This study demonstrates sex-based differences related to skin desquamating disorders, and these outcomes, coupled with known disparities in burns, may indicate a need for hypervigilance in inpatient management for women, and a re-evaluation of prognostic scoring tools to include a variable for gender.