Description

Toxic epidermal necrolysis (TEN) is a rare, life-threatening skin reaction, usually caused by a medication. It is a severe form of Stevens-Johnson syndrome (SJS). In people with SJS , TEN is diagnosed when more than 30% of the surface of the affected skin and the moisture from the lining of the body (mucous membranes) has damage.

TEN is a life-threatening condition that affects people of all ages. TEN is usually treated in a hospital. While the skin heals, the supportive care includes pain control, wound care and making sure that you are getting enough fluids. Recovery may take weeks to months.

If your condition was caused by a medication, you'll need to permanently avoid the consumption of drugs and the related with it.

Symptoms

Toxic epidermal necrolysis. signs and symptoms include:

  • Widespread skin pain
  • The extension of the rash that covers more than 30% of the body
  • The blisters and large areas of peeling skin
  • Pain, swelling, and crusting of the mucous membranes, including the mouth, eyes, and vagina

When to see a doctor

Early treatment is key for people with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). If you have symptoms, seek medical attention immediately. It is likely that you need care from a skin specialist (dermatologist) and other experts in a hospital.

Causes

SJS/TEN is usually caused by a skin reaction to the medicine. The symptoms are likely to begin to appear from one to four weeks after you start taking a new medication.

The most common drug triggers of SJS/TEN include antibiotics, drugs for epilepsy, sulfa drugs, and allopurinol (Aloprim, Zyloprim).

Risk factors

Factors that increase the risk of SJS/TEN include:

  • The HIV infection. Among people with HIV, the incidence of SJS/TEN is approximately 100-fold greater than among the general population.
  • A weakened immune system. The immune system can be affected by an organ transplant, HIV/AIDS, and autoimmune diseases.
  • Cancer. People with cancer, especially cancer of the blood (hematologic malignancies), are at increased risk for SJS/TEN .
  • A story ofSJS/TEN. If you have had a medication-related form of this condition, you are at risk of a recurrence if the drug is used again.
  • A history of the family ofSJS/TEN. If a first-degree relative, such as a parent or a sibling has had SJS/TEN , which may be more susceptible to develop also.
  • Genetic factors. Having certain genetic variations that put you at greater risk of SJS/TEN , especially if you are also taking medicines for seizures, gout, or mental illness.

Complications

The people most at risk of TEN complications are those over 70 years of age and those who have cirrhosis of the liver, or spread (metastasis) of cancer. Complications of TEN include:

  • Blood infection (sepsis). Sepsis occurs when bacteria from an infection entering the bloodstream and spread throughout your body. Sepsis is a rapidly progressing, life-threatening condition that can cause shock and multiple organ failure.
  • Involvement of the lungs. This can cause coughing, breathing difficulty, and, with a serious disease, and acute respiratory failure.
  • The Visual impairment. TEN can cause eye problems, such as dry eye, ingrown eyelashes, scarring of the cornea and, rarely, blindness.
  • Permanent skin damage. After recovering from TEN , your skin may have bumps, scars, and discoloration. Lasting to the problems of the skin could cause your hair to fall out, and the nails of the hands and feet can not grow normally.
  • Vaginal sores. In women, TEN can cause sores in the lining of the vagina, causing pain or, if left untreated, vaginal fusion.
  • The emotional distress. This condition causes distress and can have long-term psychological effects.

Prevention

To prevent another episode of TEN , to know if it was caused by a medication. If so, you will never take that drug or something similar again. A recurrence could be worse, and life-threatening. Also report any future health care providers about their history of TEN , and wear a medical alert bracelet or necklace with information about your condition. Or take an allergy passport.

Diagnosis

TEN is diagnosed when people with SJS develop serious illness that affects more than 30% of the body.

Treatment

If your doctor suspects that the TEN was caused medication that you took, you will need to stop taking that medicine. It is likely to be moved to a hospital for treatment, possibly in its center, burn unit or intensive care unit. The full recovery may take several months.

Supportive care

The main treatment for TEN is trying to make it as comfortable as possible while your skin heals. You will receive this supportive care while in the hospital. This could include:

  • Fluid replacement and nutrition. Because the skin of the loss can result in the loss of fluid from the body, it is vital to replace the fluids and electrolytes. You can receive fluids and nutrients through a tube inserted in the nose and guide into the stomach (nasogastric tube).
  • Wound care. Your health care team can gently clean the affected skin and apply special dressings, infused with petroleum jelly (Vaseline) or medication. Your health care team also monitored for the infection and given antibiotics if necessary.
  • Help with breathing. You may need to have tests and procedures to evaluate the respiratory tract and help keep it clean. With advanced disease, you may need intubation or mechanical ventilation (ventilation).
  • The control of pain. You will receive pain medication to reduce discomfort. For pain in the mouth, can be given a mouth rinse that contains a numbing agent, such as lidocaine.
  • Care of the eyes. For mild cases of the eyes of the symptoms, you can benefit from the application of preservatives, artificial tears, at least, four times a day. Drops for the eyes with corticosteroids could be used for the control of the ocular inflammation. Your care team may include an eye specialist (ophthalmologist).

Drugs

Treatment of TEN may also include one or a combination of medications that affect the entire body (systemic drugs), such as cyclosporine (Neoral, Sandimmune), etanercept (Enbrel) and intravenous immunoglobulin (IVIG). Further studies are needed to determine its benefits, if any.

Symptoms and treatment of TEN