Toxic Epidermal Necrolysis (TEN)
Introduction
It is a severe life-threatening disorder with generalized loss of epidermis and mucosa. HIV disease increases the risk of developing TEN.
Signs & symptoms
• Prodrome of fever, stinging of eyes, and discomfort in swallowing.
• Sudden appearance of diffuse macules or diffuse erythema,
• Early sites of cutaneous involvement are the presternal region of the trunk and the face, but also the palms and soles.
• Involvement of the buccal, genital and/or ocular mucosae (with erythema and erosions) occurs in more than 90% of patients, and in some cases the respiratory and gastrointestinal tracts are also affected.
• Then prompt progression with widespread erythema and peeling of skin; skin lies in sheets and folds on the bedding.
Diagnostic criteria
• Prodrome of fever, stinging of eyes, and discomfort in swallowing.
• Sudden appearance of diffuse macules or diffuse erythema,
• Early sites of cutaneous involvement are the presternal region of the trunk and the face, but also the palms and soles.
• Involvement of the buccal, genital and/or ocular mucosae (with erythema and erosions) occurs in more than 90% of patients, and in some cases the respiratory and gastrointestinal tracts are also affected.
• Then prompt progression with widespread erythema and peeling of skin; skin lies in sheets and folds on the bedding.
Investigation
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Treatment
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Non-Pharmacological treatment
- • A critical element of supportive care is the management of fluid and electrolyte requirements
• Wounds should be treated conservatively, without skin debridement
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Pharmacological
- Patient has to be admitted for close care
• Prednisolone (PO) 1–2mg/kg daily for 5–7 days.
• Intravenous fluid should be given to maintain urine output of 50–80 mL per hour with 0.5% Sodium Chloride supplemented with 20 mEq of KCI.
Note: Ophthalmologic monitoring is essential, as risk of scarring and blindness is significant. Topical sulfa containing medications should be avoided and systemic corticosteroids, if employed, should be used early to attempt to abort the immunologic reaction (first 24 hours). Later in the course, they probably increase risk of infection and slow healing.
Prevention
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Updated on,
3 Novemba 2020, 12:39:44
References
- 1.STG