Onset Of Toxic Epidermal Necrolysis Research Articles

Early Recognition and Prevention of Toxic Epidermal Necrolysis: A Cautionary Report of Two Cases and Literature Review

Toxic epidermal necrolysis (TEN) is a rare and devastating side effect of medication use characterized by epidermal apoptosis associated with massive epidermal dissociation over more than 30% of the total body surface area; fever; bullae; and generalized rash. This reaction often initially presents in the form of oral facial rashes and erosions. It is regularly misdiagnosed as less extensive forms of pemphigoid conditions, erythema multiforme, and Stevens-Johnson syndrome. The early signs are initially seen by primary care physicians and dental care providers, especially oral and maxillofacial surgeons. Incidence of TEN is low, and presentation of the disease is rapid and distinguishable. The first-line treatment staple for TEN is immediate cessation of the offending drug; however, this is complicated by the prevalence with which TEN-causing drugs are prescribed. Among others, onset of TEN is associated with nonsteroidal anti-inflammatory drugs; sulfonamides; cephalosporins; aromatic anticonvulsants; and allopurinol, making early identification difficult. Furthermore, duration of TEN is associated with medication clearance, which can complicate treatment when TEN is caused by drugs with long half-lives.

Toxic epidermal necrolysis caused by over the counter eyedrops

We present a case of a 15-year-old boy who developed toxic epidermal necrolysis (TEN) from sulfacetamide eyedrops. He presented with conjunctival injection and an erythematous rash that rapidly progressed to epidermal necrosis of over 30% of his body. A skin biopsy revealed an acute lichenoid reaction pattern consistent with TEN. After 22 days in hospital, he was left with significant scarring to his eyes, mouth and anogenital areas. An extensive search for an infective aetiology was negative. Previously exposed to bactrim tablets, he used Bleph-10 eyedrops 3 days before admission to hospital. The patient had a strong family history of sulphur allergy. The onset of TEN after topical administration of medication has been reported rarely in the literature. This case highlights the need for a thorough medication history that includes topical preparations.

Maladie de Hodgkin à début aigu au décours d’un syndrome de Lyell

In most cases, toxic epidermal necrolysis is a drug-induced reaction. Other causes such as lymphomas have also been suspected. We report herein a new association of toxic epidermal necrolysis and Hodgkin's disease in a male patient. A 62-year-old man consulted for erythroderma, scalded skin and mucous erosions involving the oral, nasal and genital areas. Nikolsky's sign was present. Cutaneous biopsy confirmed the diagnosis of toxic epidermal necrolysis. Our patient acknowledged intake of fexofenadine 48 hours before the eruption. He also developed enlarged lymph nodes whose histopathological examination revealed Hodgkin's disease. Exploration of cytolytic hepatitis disclosed replicating chronic viral B hepatitis. The skin disorder quickly improved and our patient underwent CHOP chemotherapy. Association of toxic epidermal necrolysis and lymphoproliferative disorders has been reported. Development of toxic epidermal necrolysis is normally related to administration of antineoplastic drugs. However, lymphomas may be diagnosed after the onset of toxic epidermal necrolysis in the absence of drug intake, pointing to a possible aetiological role of haematological disease in the development of toxic epidermal necrolysis.

AQUACEL ® Ag in the treatment of toxic epidermal necrolysis (TEN)

Toxic Epidermal Necrolysis (TEN) is life-threatening dermatological disease characterized by extensive destruction of the epidermis is associated with a 25–60 % mortality rate in adults. We presented one patient with TEN with 86% skin slough treated successfully using AQUACEL ® Ag exclusively. All of the wounds were healed completely 8 days after onset of TEN. AQUACEL ® Ag is an efficient and cost-effective adjunct in the treatment of TEN.

Chronic pulmonary complications associated with toxic epidermal necrolysis: Report of a severe case with anti‐Ro/SS‐A and a review of the published work

Patients with toxic epidermal necrolysis (TEN) have been known to have various complications. Though pulmonary complications are often observed, they usually show an acute form; however, chronic complications are quite rare and little is known about either their incidences or clinical manifestations. We herein report a 33-year-old man who presented with chronic pulmonary complications after a recovery from TEN. At the onset of TEN, he had severe respiratory failure and artificial ventilation was instituted. Despite being extubated successfully, respiratory failure reappeared 1 month later. A diagnosis of chronic bronchitis with severe obstructive ventilatory impairment and bronchiectasis was made and he was treated with steroids, bronchodilators and antibiotics, however, he died 1.5 years after the onset of TEN. There have been 13 reported cases of chronic pulmonary complications with TEN or Stevens-Johnson syndrome (SJS) in the English published work. Such cases are usually classified into chronic bronchitis/bronchiolitis with obstructive change (including bronchiolitis obliterans and bronchiolitis obliterans organizing pneumonia), respiratory tract obstruction and bronchiectasis. Approximately 40% of all such patients die while the surviving continue to suffer from these complications because no curative therapy yet exists. As a result, the prognosis seems to be poor. The relationship between TEN and these chronic pulmonary complications remains to be elucidated. Interestingly, our patient was asymptomatically anti-Ro/SS-A positive at the onset of TEN. In addition, eccrine gland involvement and an extremely high level of serum salivary amylase were observed at the onset of TEN, furthermore, Sjögren-like symptoms occurred after recovery from TEN. These findings suggested that the Sjögren-like autoimmune abnormalities induced by anti-Ro/SS-A correlated with the development of chronic pulmonary complications in our patient.

Characteristics of Toxic Epidermal Necrolysis in Patients Undergoing Long-term Glucocorticoid Therapy

The usefulness of steroid therapy in toxic epidermal necrolysis (TEN) remains controversial. Up to 5% of the TEN cases occur in patients who undergo long-term steroid therapy. We, thus, looked for the potential effect of long-term glucocorticosteroid therapy before the onset of TEN on altering the progression of the disease. The records of 179 patients were reviewed. The characteristics of the 13 patients who were undergoing long-term glucocorticosteroid therapy were compared with those of 166 other patients with TEN. The following parameters were studied: age, mortality, delay between the introduction of the suspect drug and the onset of TEN, length of hospital stay, body surface area involved, time elapsed between the first symptom of TEN and hospital admission, number of medications taken by the patients before the onset of TEN, lymphocyte count, granulocyte count, platelet count, glycemia, serum aspartate aminotransferase level, and total disease duration. Patients who were undergoing long-term glucocorticosteroid therapy differed from other patients with TEN in the administration of more drugs, longer delay between the introduction of the suspect drug and the onset of TEN, and a longer time elapsed between the first symptom of TEN and hospital admission. We observed no differences for the other parameters that were studied. Our study shows that long-term steroid therapy may delay the onset of TEN, but it does not halt its progression.