Toxic Epidermal Necrolysis

Toxic Epidermal Necrolysis General Information

Toxic Epidermal Necrolysis abbreviated TEN and also known as Lyell’s syndrome is an extremely dangerous dermatological condition that can threaten the patient’s life. This type of medical disorder is frequently caused by an extreme and severe reaction to certain medicines. The main groups of drugs known to cause TEN are: Allopurinol, antibiotics (Quinolones, Sulphonamides, Macrolides or Penicillin), antiepileptic medicines (anticonvulsants) and NSAIDs (Non-steroidal anti-inflammatory drugs). There can also be non-medication causes, for example: no apparent causes, vaccinations, viral or bacterial infections or malignant tumors.

Patients who suffer from this terrible dermatological problem have extreme pains and look as they have been burned. Characteristic for Toxic Epidermal Necrolysis is that the epidermis (the top layer of the skin) detaches very easily from the dermis (the lower layer of the skin) all over the patient’s body. Scientists consider it the severe form of another similar medical condition, called Stevens-Johnson syndrome (SJS). The epidermis represents a barrier between the nature and body that protects the internal components of an organism from the harmful agents. Once this layer of the skin is removed, the body is more exposed to infections and various diseases that spread rapidly and attack the immune system. The incidence of this skin disorder is between 0.3 to 1.5 cases per million, each year, all around the world. Before deciding what treatment to apply, the health care provider must distinguish Toxic Epidermal Necrolysis from other similar conditions, such as staphylococcal scalded skin syndrome; to do this, biopsy of the skin is necessary.

Toxic Epidermal Necrolysis Symptoms   

A skin disorder of such proportion as Toxic Epidermal Necrolysis affects large areas of the body, but it appears more often around the mucous membranes, for example vagina, mouth or eyes. Toxic Epidermal Necrolysis presents some specific signs and symptoms that characterize almost all the cases and vary in intensity, from mild, to critical symptoms that affect the patient’s quality of life. We will offer you a list of the most encountered signs and symptoms, but if you need more information, we advise you to contact your health care provider or other specialist in this type of disorders. Our list may not be complete because each organism has a particular reaction to various harmful agents and this is why some people may experience particular signs and symptoms.

Toxic Epidermal Necrolysis usually begins its developmental process with one or two days of flu-like manifestations (such as sore throat, general aches, fever, pains, runny nose and cough). The critical phase starts after these few days and usually lasts between 10 to 15 days. The signs and symptoms of this last stage are more severe and painful and if they are not treated in time, the patient’s life is in real danger. Some of these symptoms are: cracked and bleeding lips that present crusts; small red spots (early measles-like rash) that develop and become painful, extending rapidly on large areas of red irritated skin; persistent fever; sore eyes (conjunctivitis) that appears one to three days before the lesions on the skin develop; extreme pain, etc.

Toxic Epidermal Necrolysis Treatment

As in the case of other similar disorders, a quick diagnosis followed by an adequate treatment option can assure a more rapid healing process and better results. This is why we strongly advise you to visit a health care provider or any other specialist in the domain (called a dermatologist) as soon as you start experiencing any of the signs and symptoms that we have listed above. Be very careful and watch closely for any change of your health status in the case you follow a treatment based on certain antibiotics or other drugs that can provoke Toxic Epidermal Necrolysis. During the medical examination you will be asked about you signs and symptoms and what medicines have you taken lately. A physical examination may be helpful. Usually, the diagnosis of this type of skin disorder can be made clinically. Because the manifestations of this medical condition are obvious and very specific, the doctor can set immediately the diagnosis. To be sure, the doctors can perform a biopsy of the affected skin. An examination of this tissue under the microscope can help a doctor to distinguish Toxic Epidermal Necrolysis from other similar conditions, such as staphylococcal scalded skin syndrome. This may be absolutely necessary for the doctor to know exactly what treatment option is adequate for the respective patient. If the tests indicate this disorder of the skin, then the patient must be immediately hospitalized in ICUs (intensive care units) or in burn units where he or she can receive the appropriate medical care.

Firstly, the health care provider will remove the culprit drugs from the patient’s prescriptions. Then, uncontrolled trials with IVIG (intravenous immunoglobulin) are preferred because they offer promising results in treating Toxic Epidermal Necrolysis. Several medicines are also used to treat this type of skin disorder: Ulinastatin, Cyclosporine, Pentoxifylline, Infliximab, Cyclophosphamide, N-acetylcysteine, Plasmapheresis, and in the case that Toxic Epidermal Necrolysis is associated with leukopenia, Granulocyte colony-stimulating factors are administrated. Systemic steroids are no longer used because they do not offer benefits all the time.

Other treatment options include: wound care, electrolyte and fluid resuscitation, pain management, surgical removal (debridement) of the dead tissues, nutritional support, intravenous (IV) Cyclosporine, hyperbaric oxygen, immunoglobulin and plasmapheresis. This is a medical condition that requires prompt medical care because it can threaten seriously the patient’s life. The mortality and morbidity rates are increased (in 25-45% of the cases) because the loss of the epidermis makes the patient vulnerable to various infections caused by bacteria or fungi. This results in septicemia that is the main cause of death when dealing with Toxic Epidermal Necrolysis. Death can also be provoked by damage to the airway’s lining or pneumonia that leads to respiratory distress. The complications appear suddenly in a matter of weeks, causing the disease to spread more rapidly and to extend on bigger areas of skin. The main aim of any type of therapy is to prevent the disease to develop to this point because saving the patient’s life is more challenging and questionable.