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Toxic Epidermal Necrolysis: Causes, Symptoms, and Treatment

Aug 14, 2023

Toxic epidermal necrolysis (TEN)

Toxic epidermal necrolysis (TEN), a rare and occasionally fatal skin response, is frequently brought on by drugs. Stevens-Johnson syndrome (SJS) affects humans in its most severe form. When there has been significant mucous membrane damage and more than 30% of the skin surface has been injured, TEN is diagnosed in SJS patients.

Anyone at any age can develop TEN, a potentially fatal illness. TEN is frequently managed at medical facilities. Controlling pain, tending to wounds, and making sure you get enough fluids are all part of supportive care, which aids in the skin's ability to heal. Before you feel better, weeks or months may pass.

The drug and any prescriptions that may have been taken with it must be stopped if it caused your condition.

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Causes Of Toxic epidermal necrolysis

Most frequently, experts believe that particular medicines cause TEN syndrome. These medicines could consist of:

  • Allopurinol
  • Anticonvulsants, a class of medications used to treat epilepsy.
  • HIV-treating antiretroviral medications, particularly NNRTIs like nevirapine, efavirenz, or etravirine.
  • Non-steroidal anti-inflammatory medicines, also known as NSAIDs, include oxicams.
  • Sulfonamides, an antibiotic class.
  • Other uncommon triggers could be:

Vaccinations for infections.

In a few instances, the reason for TEN remains unknown.

Symptoms Of Toxic Epidermal Necrolysis

The following are the signs and symptoms of toxic epidermal necrolysis:

  • Generalized skin pain
  • A widespread rash that covers more than 30% of the body Blisters and significant skin peeling
  • Mucous membranes, such as those in the mouth, eyes, and vagina, develop sores, swelling, and crusting.

Risk Factors for Toxic epidermal necrolysis

Your risk of SJS/TEN is affected by the following factors:

  • The HIV virus. TEN is 100 times more common among HIV-positive individuals than it is in the general population.
  • A compromised immune system. HIV/AIDS, autoimmune illnesses, and organ transplants can all have an impact on the immune system.
  • Cancer TEN risk is higher in those who have cancer, particularly hematologic malignancies (blood cancers).
  • A history of  TEN. You run the danger of a recurrence if you use that medication again if you've experienced a medication-related variant of this ailment.
  • A family history of TEN. You might be more prone to getting SJS/TEN if a first-degree relative, like a parent or sibling, has had it.
  • Genetic factors. You are more likely to develop SJS/TEN if you have specific genetic abnormalities, especially if you also take medication for gout, seizures, or a mental health condition.

Diagnosis Of Toxic Epidermal Necrolysis

Your doctor will often identify TEN by looking at your skin and symptoms. The diagnosis could occasionally need to be confirmed by a skin biopsy. An expert in human tissue analysis known as a pathologist analyses a sample of your skin under a microscope. According to a biopsy:

  • Cells of skin that is necrotic or dead.
  • Skin's top layer, the epidermis, and its base layer, the dermis, are separated.

Treatment Of Toxic epidermal necrolysis

You must stop using the medication if your doctor believes it contributed to your TEN. After that, you'll probably be taken to a hospital where you'll receive treatment, perhaps in the burn centre or intensive care unit. 

Making you as comfortable as possible as your skin heals is the major goal of treating TEN. This supportive care will be given to you while you are hospitalised. It might consist of:

  • Rehydration and nourishment. Electrolytes and fluids must be replaced because skin loss can cause the body to lose liquids. A tube (nasogastric tube) that is put in the nose and sent to the stomach may be used to administer fluids and nutrients to you.
  • Wound treatment. Your medical team may use special dressings impregnated with Vaseline or medication while also carefully cleaning the damaged skin. Additionally, your care team keeps an eye out for infections and administers antibiotics as necessary.
  • It helps to breathe. To assess your airway and maintain its clarity, you might need tests and procedures. You might require intubation or mechanical ventilation if your condition is advanced.
  • Pain management. Painkillers will be given to you to ease your suffering. You might be given mouthwash that contains a numbing chemical, such lidocaine, if you are experiencing oral pain.
  • Eye treatment. Apply preservative-free artificial tears at least four times daily to treat any minor eye complaints. Corticosteroid eye drops may be used to treat ocular irritation.
  • Ophthalmologists are doctors who specialize in the eyes.


In addition, systemic medicines such as cyclosporine (Neoral, Sandimmune), etanercept (Enbrel), and intravenous immunoglobulin (IVIG) may be used alone or in combination to treat TEN. To ascertain their benefit, if any, further research is required.

Prevention of Toxic epidermal necrolysis 

Discover whether a medication was the cause in order to stop another occurrence of TEN. If so, avoid taking that medication or any others like it in the future. A recurrence can be more severe and perhaps fatal. Additionally, disclose your history of TEN to any potential healthcare providers and wear a medical alert necklace or bracelet that includes information about your disease. or travel with an allergy passport.

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