Toxic epidermal necrolysis

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Obesity, Sleep & Internal medicine
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Toxic epidermal necrolysis
Toxic epidermal necrolysis
Synonyms	TEN, Lyell's syndrome
Pronounce	N/A
Specialty	N/A
Symptoms	Fever, malaise, widespread skin necrosis, mucous membrane involvement
Complications	Sepsis, dehydration, organ failure
Onset	Sudden
Duration	Days to weeks
Types	N/A
Causes	Drug reaction, infection, idiopathic
Risks	HIV, systemic lupus erythematosus, cancer
Diagnosis	Clinical diagnosis, skin biopsy
Differential diagnosis	Stevens-Johnson syndrome, staphylococcal scalded skin syndrome, pemphigus vulgaris
Prevention	N/A
Treatment	Supportive care, intravenous immunoglobulin, corticosteroids
Medication	N/A
Prognosis	Variable, high mortality rate
Frequency	Rare
Deaths	N/A

Toxic epidermal necrolysis is a severe rash in which the outer layers of skin blister and peel off.

Skin reaction

• Toxic epidermal necrolysis (TEN) is a type of severe skin reaction.
• Together with Stevens-johnson syndrome (SJS) it forms a spectrum of disease, with TEN being more severe.

Symptoms

• Early symptoms include fever and flu-like symptoms.
• A few days later the skin begins to blister and peel forming painful raw areas.
• Mucous membranes, such as the mouth, are also typically involved.

Treatment

• Treatment needs should be assessed in the hospital to determine severity and where treatment should be provided (e.g. intensive care unit, burn unit, or dermatology unit).
• Treatment may involve stopping a triggering medication (for those suspected of having medication-induced SJS/TEN), standard therapies used for major burns, various eye treatments (for those with eye involvement), pain control, and preventing and treating infections.

Mortality

The overall mortality rate is about 25%, ranging from about 10% for SJS to over 30% for TEN.

Cause of death

The most common causes of death include sepsis, acute respiratory distress syndrome, and multiple organ failure.

Complications

• Those that survive may experience recurrence (particularly if re-exposed to a trigger) and/or long-term complications involving the skin and affected mucous membranes.
• Complications include dehydration, sepsis, pneumonia, and multiple organ failure.

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