Toxic epidermal necrolysis [Neurosurgery Wiki]

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====== Toxic epidermal necrolysis ======

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Toxic epidermal necrolysis (TEN) is a type of severe skin reaction. Together with [[Stevens-Johnson syndrome]] (SJS) it forms a spectrum of diseases, with TEN being more severe.

===== Differential diagnosis =====


Stevens-Johnson Syndrome (SJS) and [[Toxic Epidermal Necrolysis]] (TEN) are rare, severe skin reactions, usually triggered by medications or infections. They are considered different levels of the same disease spectrum.


<WRAP column 40%>
{{:images:warning_icon.png?nolink&30|}} **Medical Emergency**: Both SJS and TEN require hospitalization, often in burn or intensive care units.
</WRAP>

<WRAP clear></WRAP>

===== Causes =====
  * **Medications** (most common):
    * Sulfonamides
    * Anticonvulsants (e.g., lamotrigine, carbamazepine)
    * Allopurinol
    * NSAIDs
  * **Infections**:
    * *Mycoplasma pneumoniae* (especially in children)
  * Unknown cause in some cases

===== Symptoms =====

  * Fever, malaise (flu-like prodrome)
  * Painful red/purplish rash
  * Blistering and peeling of skin
  * Involvement of **mucous membranes**:
    * Eyes (conjunctivitis)
    * Mouth (ulcerations)
    * Genitals


===== Comparison Table =====

^ Feature ^ Stevens-Johnson Syndrome (SJS) ^ Toxic Epidermal Necrolysis (TEN) ^
| **Skin detachment** | <10% of body surface area (BSA) | >30% of BSA |
| **Overlap form** | Not applicable | SJS/TEN overlap: 10–30% BSA |
| **Severity** | Severe | Life-threatening |
| **Mortality rate** | ~5–10% | ~30–50% |
| **Treatment** | Stop causative drug, supportive care | Same, but more intensive (ICU/Burn Unit) |

===== Management =====
  * Immediate withdrawal of suspected drug
  * Hospital admission (ICU or burn unit)
  * Skin care, fluid and electrolyte support
  * Pain management
  * Prevention of secondary infections
  * Sometimes: corticosteroids, IVIG, cyclosporine

===== Long-Term Complications =====
<folded|Click to expand: Possible long-term effects>
  * Chronic skin problems
  * **Ocular damage** (e.g., dry eye, blindness)
  * Oral/genital mucosal scarring
  * Psychological trauma
</folded>

===== References =====
  * Roujeau JC, Stern RS. Severe adverse cutaneous reactions to drugs. _N Engl J Med._ 1994.
  * Harr T, French LE. Toxic epidermal necrolysis and Stevens-Johnson syndrome. _Orphanet J Rare Dis._ 2010.
  * [https://www.uptodate.com/contents/stevens-johnson-syndrome-toxic-epidermal-necrolysis | UpToDate Entry]

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