Medical Description

Toxic epidermal necrolysis (TEN) is a rapidly evolving mucocutaneous reaction characterized by widespread erythema, necrosis, and bullous detachment of the epidermis resembling scalding.

The general feeling in the medical community is that TEN is the most severe stage of Stevens-Johnson syndrome (SJS), a life-threatening illness that shares many of the same symptoms and potential causes.

Source: Gregory P Garra, “Toxic epidermal necrolysis,” eMedicine, June 13, 2005 and accessed June 27, 2007.

Symptoms

• Mucocutaneous lesions (blisters and rashes) especially around the lips, throat and face or on the trunk, which may become bulbous and later rupture
• Patients may not be able to eat or drink due to the severe blistering of the lips and other mucous membranes
• symptoms of upper respiratory tract infection
• vomiting and diarrhea, leading to dehydration
• fever
• Tachycardia (rapid heartbeat)
• Hypotension (extremely low blood pressure)
• Epistaxis (bleeding from the nose)
• Conjunctivitis (inflammation of the white part of the eye)
• Seizures, coma

General Information

Toxic epidermal necrolysis (TEN) is a life-threatening skin reaction that can be caused by several factors including an allergic reaction to a particular drug. TEN is a type of immune complex mediated hypersensitivity in the most severe form that can cause skin to blister and peel.

TEN spreads rapidly, usually within 3 to 5 days. Symptoms of TEN include peeling of the skin in sheets, leaving large raw areas of open flesh. The loss and damage of skin is similar to burn victims as fluids and important minerals ooze from damaged areas which can be easily infected.

Treatment for TEN is typically treated in the burn unit. Treatment includes isolation of the affected areas to prevent further infection, protective bandages, intravenous fluids and electrolytes and antibiotics.

The mortality rate of TEN is between 30 and 40 percent; however, chances of acquiring the disease are rare. According to eMedicine, the worldwide odds of contracting the disease are .4 to 1.2 in one million.

Select prescription medications can cause the disease, and many medications carry warnings that list the drug as a causative agent. The most commonly indicted medicines are:

• Sulfonamide antibiotics
• Anticonvulsants (phenobarbital, phenytoin, carbamazepine, valproic acid)
• Oxicam nonsteroidal anti-inflammatory drugs (NSAIDs)
• Allopurinol
• Antiretroviral medications
• Corticosteroids

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