Toxic epidermal necrolysis

• Toxic epidermal necrolysis caused by phenobarbital: a case report and literature review
• Toxic epidermal necrolysis after injection of sclerosing agent and medical adhesive into oesophageal variceal ligation in a patient with a malignant liver tumour: A case report
• Carbamazepine-modified HLA-A*24:02-bound peptidome: Implication of CORO1A in skin rash
• Patients With Suspected Severe Adverse Reactions to COVID-19 Vaccination Admitted to Intensive Care Unit: A Case Report
• Phenytoin induced Stevens-Johnson Syndrome-toxic Epidermal Necrolysis Overlap Exacerbated by Cephalexin in a 65-Year-old Neurosurgical Patient: A Rare Case Report
• Toxic epidermal necrolysis syndrome induced by tigecycline: a case report
• Carbamazepine adverse drug reactions
• Association of <em>HLA-A</em> and <em>HLA-B</em> Alleles with Lamotrigine-Induced Cutaneous Adverse Drug Reactions in the Thai Population

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.

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.

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

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

• 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

<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>

• 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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