Dr. Orwa Nasser MD MPH - Toxic Epidermal Necrolysis (TEN):

Toxic Epidermal Necrolysis (TEN):

Toxic Epidermal Necrolysis (TEN) is a rare, life-threatening skin disorder in which large areas of skin and mucous membranes blister and peel away. It represents the most severe form on the Stevens-Johnson syndrome spectrum and typically involves more than 30 percent of the body surface. TEN is most commonly triggered by medications and requires immediate hospitalization and intensive medical care.

Symptoms:

    ·    Flu-like symptoms including fever, fatigue, and body aches.

    ·    Rapidly spreading red or painful skin rash.

    ·    Large blisters and sheets of skin peeling away.

    ·    Painful open skin areas.

    ·    Mouth, eye, throat, or genital involvement.

    ·    Light sensitivity and eye irritation.

    ·    Difficulty swallowing, urinating, or breathing in severe cases.

Causes: Most cases of TEN are caused by severe adverse reactions to medications.

·    Medication reactions: Common triggers include certain antibiotics, anticonvulsants, non-steroidal anti-inflammatory drugs, allopurinol, and antiretroviral medications.

·    Infection-associated triggers: Infections may rarely trigger TEN, particularly in individuals with immune system abnormalities.

·    Genetic and immune risk factors: Genetic susceptibility and immune system variations may increase the risk of severe drug reactions leading to TEN.

Diagnosis and Tests: Diagnosis is based on clinical evaluation, medication history review, and physical examination of blistering and peeling skin. A skin biopsy may confirm full-thickness epidermal necrosis. Laboratory testing helps assess dehydration, infection risk, and organ involvement.

Management and Treatment: TEN is a medical emergency that requires hospitalization, often in a burn unit or intensive care setting.

·    Immediate measures: The suspected triggering medication must be stopped immediately. Fluid replacement, wound care, infection prevention, and pain management are essential.

·    Supportive care: Care focuses on maintaining body temperature, nutrition, and organ function.

·    Immune-modulating treatments: Selected patients may receive therapies such as corticosteroids, intravenous immunoglobulin, or cyclosporine based on clinical judgment.

Prognosis: TEN carries significant risk of complications including infection, dehydration, and organ failure. Mortality rates vary depending on severity and patient factors. Survivors may experience long-term complications affecting the skin, eyes, and mucous membranes.

Prevention: Prevention focuses on avoiding known medication triggers and seeking immediate care if rash or flu-like symptoms develop after starting a new drug.

When Should I See My Healthcare Provider? Seek immediate medical attention if you develop a rapidly spreading rash, blistering skin, or painful mucosal lesions.

When Should I Go to the Emergency Room? Go to the emergency room immediately for large areas of skin peeling, severe pain, difficulty breathing, or rapid symptom progression.

What Questions Should I Ask My Healthcare Provider?

    ·    Could this be Toxic Epidermal Necrolysis?

    ·    What medication may have triggered this reaction?

    ·    What treatments are required?

    ·    What complications should be monitored?

    ·    What follow-up care is needed after recovery?

Key Takeaways:

    ·    Toxic Epidermal Necrolysis is a rare and life-threatening skin condition.

    ·    Most cases are caused by severe medication reactions.

    ·    Immediate hospitalization is required.

    ·    Early diagnosis and supportive care improve survival.

    ·    Long-term complications may occur even after recovery.