Toxic Epidermal Necrolysis

Toxic Epidermal Necrolysis

Toxic Epidermal Necrolysis: A Life-Threatening Skin Condition

What is Toxic Epidermal Necrolysis?

Toxic epidermal necrolysis (TEN) is a rare but life-threatening skin condition that causes the top layer of the skin to detach from the lower layers. This can lead to widespread blistering, peeling, and pain. TEN is often caused by a reaction to certain medications, such as antibiotics and anti-seizure medications.

Symptoms of TEN

The symptoms of TEN typically develop within a few days to weeks after taking the offending medication. The most common symptom is a widespread rash that starts on the trunk and spreads to the face, arms, and legs. The rash can be extremely painful and may cause blisters and peeling. Other symptoms of TEN include:

• Fever
• Chills
• Nausea
• Vomiting
• Diarrhea
• Muscle aches
• Joint pain
• Eye pain
• Swollen lymph nodes

Causes of TEN

The most common cause of TEN is a reaction to certain medications. The medications that most commonly cause TEN include:

• Antibiotics, such as sulfonamides and penicillin
• Anti-seizure medications, such as phenytoin and carbamazepine
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen
• Allopurinol, a medication used to treat gout
• Gold salts, a medication used to treat rheumatoid arthritis

TEN can also be caused by other factors, such as:

• Viral infections, such as herpes simplex virus and Epstein-Barr virus
• Bacterial infections, such as Staphylococcus aureus
• Burns
• Radiation therapy

Diagnosis of TEN

The diagnosis of TEN is based on the patient’s symptoms and a physical examination. A biopsy of the skin may also be performed to confirm the diagnosis.

Treatment of TEN

The treatment of TEN is supportive and includes:

• Stopping the offending medication
• Treating the symptoms, such as pain and infection
• Providing supportive care, such as fluids and nutrition

The prognosis for TEN is variable. With early diagnosis and treatment, the mortality rate is about 30%. However, the mortality rate is higher in patients who have extensive skin involvement or who develop sepsis.

Prevention of TEN

The best way to prevent TEN is to avoid taking medications that have been associated with the condition. If you must take one of these medications, be sure to tell your doctor about your risk of TEN. Your doctor may recommend taking a lower dose of the medication or taking it for a shorter period of time.