Abstract
Toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, is a rare, life-threatening and wide-spread exfoliative disease of the skin and mucous membrane that is most commonly drug-induced. We retrospectively reviewed the charts of 17 patients who suffered from TEN in Farhat Hached University Hospital, Sousse, Tunisia over a 19-year period from January 1994 to January 2013. Causality for suspected drugs was assessed by means of the Naranjo adverse drug reaction (ADR) probability scale. Antibiotics, mainly ß-lactams, were the most common implicated drugs, followed by nonsteroidal anti-inflammatory drugs, anticonvulsants, and allopurinol. The interval between drug intake and onset of the first symptom ranged between few hours and 19 days with a mean period of 6.11 days. There was extensive skin detachment, averaging 66.17% of total body surface area (range 40-95%). The most major complication was infection, occurring in 9 patients (53%). Seven patients died with a mortality rate of 41%.
Highlights
Toxic epidermal necrolysis (TEN), known as Lyell’s syndrome, is a rare, life-threatening and wide-spread exfoliative disease of the skin and mucous membrane that is most commonly drug-induced [1]
We retrospectively reviewed the medical charts of 17 patients who suffered from TEN in Farhat Hached University Hospital, Sousse, Tunisia over a 19-year period from January 1994 to January 2013
The causality of TEN with suspected drugs was assessed by means of the Naranjo adverse drug reaction (ADR) probability scale [5]
Summary
Toxic epidermal necrolysis (TEN), known as Lyell’s syndrome, is a rare, life-threatening and wide-spread exfoliative disease of the skin and mucous membrane that is most commonly drug-induced [1]. The reported incidence for TEN varies from 0.4 to 1.9 cases per million inhabitants per year [2,3]. In the majority of cases, drugs are assumed or identified as the main cause of TEN. The most frequently implicated drugs are antibiotics, anti-convulsants, nonsteroidal anti-inflammatory drugs (NSAIDs) and allopurinol. Little work has been carried out in Tunisia on the epidemiology of the most serious skin reaction—TEN and was limited to case reports. The present study was conducted to present the local epidemiology, clinical features, aetiology and complications of this disorder in a University Hospital in Tunisia during a 19-year-period
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