Toxic Epidermal Necrolysis also known as Lyell’s syndrome and life-threatening. It is characterized by the detachment of the top layer of skin, (epidermis) from the lower layers of the skin (dermis) all over the body. The lesion resembles that of a severe burn and needs to be distinguished from staphylococcal scalded skin syndrome, which has a similar appearance but the blister arises nearer to the skin surface. A skin biopsy is often necessary to distinguish these two diseases.Toxic epidermal necrolysis is a rare and usually severe adverse reaction to certain drugs. The drugs most often implicated in TEN are certain antibiotics , penicillin, quinolones), NSAIDs ,acetaminophen, certain seizure drugs (carbamazepine, phenytoin, valproic acid), and corticosteroids.
Non-drug causes include bacterial or viral infection, malignant tumours, vaccinations or no apparent cause (idiopathic). TEN usually starts with 2-3 days. Symptoms of TEN include peeling of the skin in sheets, leaving large raw areas of open flesh. The loss and damage of skin, similar to what occurs in burn victims, allows fluids and important minerals to ooze from the damaged areas. These areas can easily become infected. These symptoms may mimic those of a common upper respiratory tract infection. When the rash appears it may be over large and varied parts of the body, and it is usually warm and appears red. TEN may occur in people of any age, race or sex. It appears to be more common in females than males.
Age older than 40 years is an independent risk factor for mortality. Treatment includes isolation of the affected areas to prevent infection, protective bandages, intravenous fluids and electrolytes and antibiotics. Use of corticosteroids to treat the disorder is controversial. These drugs suppress the immune system, which increases the potential for serious infection. Systemic steroids are unlikely to offer any benefits. Chlorhexidine solution is used to bathe the patient’s skin. Apply chloramphenicol ointment to prevent infection. Avoid use of silver sulfadiazine cream. Silvadene cream is a sulfa medication, a category of drugs often implicated as a cause of toxic epidermal necrolysis. Apply Kerlix dressings soaked in silver nitrate 0.5% to involved areas after each whirlpool session.
Toxic Epidermal Necrolysis Treatment and Prevention Tips:
1. Avoid use of silver sulfadiazine cream.
2. Apply chloramphenicol ointment to prevent infection.
3. System corticosteroids are useful in the treatment of TEN.
4. Chlorhexidine solution is used to bathe the patient’s skin.
5. Use of corticosteroids to treat the disorder is controversial.
6. In many cases, intravenous human immunoglobulin (IVIg) to treat toxic epidermal necrolysis.
