Phase Of Toxic Epidermal Necrolysis Research Articles

Pruritus as an early sign of abnormal scarring in the re-epithelialising phase of Toxic Epidermal Necrolysis.

We present a 28-year-old remote-living male who presented to our dermatology clinic with increasing pruritus over his torso and limbs in the context of a recent admission for Toxic Epidermal Necrolysis (TEN) secondary to paliperidone depot. Our case demonstrates that pruritus in the re-epithelialising phase of TEN may be a sign of abnormal scarring. Early assessment and measurement for compression garments is recommended.

Amniotic membrane grafting for conjunctival and lid surface disease in the acute phase of toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) is a severe form of Stevens-Johnson syndrome, characterized by extensive sloughing of mucous membranes and skin. It is associated with mortality rates of up to 70% and significant ocular morbidity in long-term survivors. We present a case of TEN with severe bilateral ocular involvement in whom we successfully used amniotic membrane grafts to treat the ocular surface during the acute phase of the disease.

Amniotic Membrane Transplantation in Acute Phase of Toxic Epidermal Necrolysis with Severe Corneal Involvement

Amniotic Membrane Transplantation in Acute Phase of Toxic Epidermal Necrolysis with Severe Corneal Involvement

Amniotic Membrane Transplantation in Acute Phase of Toxic Epidermal Necrolysis with Severe Corneal Involvement

To report successful management of acute stage toxic epidermal necrolysis (TEN) by amniotic membrane transplantation. Interventional case report. METHOD/INTERVENTION: A 6-year-old boy who had convulsions and fever due to encephalitis was treated by oral phenobarbital. Two weeks later, he developed a high fever and skin rashes involving >40% of the body, with a positive Nikolsky sign and oral blisters. Examination under general anesthesia performed 5 days after the onset of eye symptoms showed severe inflammation and ulceration on the lid margin and the tarsal conjunctiva in both eyes, a total corneal epithelial defect in the right eye, and a geographical corneal epithelial defect in the left eye. Amniotic membrane was transplanted in both eyes as a patch to cover the entire ocular surface, including upper and lower lid margins. Fourteen days after amniotic membrane transplantation, complete corneal and conjunctival epithelialization was observed in the left eye. However, a second amniotic membrane transplantation was performed in the right eye, which still had a total corneal and conjunctival epithelial defect, and resulted in complete epithelialization 14 days later. Corrected visual acuity improved to 20/16 without any superficial punctate keratitis in both eyes 6 months postoperatively. Minimal symblepharon and peripheral scarring were observed only in the right eye. Amniotic membrane transplantation performed at the acute phase of TEN is highly effective not only in reducing inflammation and preventing scarring in the conjunctival surface, but also in restoring corneal epithelial integrity in eyes with both corneal and conjunctival ulceration. As a result, in this case it prevented sight-threatening cicatricial complications at the chronic stage.

Ulcérations muqueuses persistantes: Une complication rare de nécrolyse épidermique toxique

Sequels can be observed in toxic epidermal necrolysis. Persistence of mucosal ulcerations is not a classical complication of this disease. We describe two case reports of mucous membrane ulcerations (oral and genital) which have remained many months after the acute phase of toxic epidermal necrolysis.Case 1. A little girl, 9 years old, was referred for a chronic and painful ulceration of the vulva that had appeared 9 months earlier during a toxic epidermal necrolysis. She presented a clearly crircumscribed vestibular ulceration. The mucosal biopsy was refused by the family. The genital erosion persisted more than one year after the acute phase. Case 2. A 73 year-old man was referred for a persistent and clearly circumscribed lingual ulceration, 9 cm in diameter. This chronic ulceration had appeared 3 months earlier, during the acute phase of a toxic epidermal necrolysis. The skin biopsy specimen, with histologic and direct immunofluorescence analysis, did not disclose any specific anomalies. After a period of clinical observation, intralesional injections of corticosteroids were decided and ulceration progressively decreased in 13 months.Complications of toxic epidermal necrolysis mainly occur at the acute phase. The most well documented sequelae are ophthalmological lesions. The most frequent cutaneous sequelae are cutaneous pigmentary changes and nail dystrophy. We report two observations of persistent mucous membrane erosions many months after the acute phase of toxic epidermal necrolysis. The pathophysiology of this complication, is rarely described and still remains unclear.

Vulvovaginal Involvement in Toxic Epidermal Necrolysis: A Retrospective Study of 40 Cases

Objective: To determine the incidence, features, and surgical treatment of vulvovaginal lesions in toxic epidermal necrolysis. Methods: Acute genital lesions were studied retrospectively in 40 women hospitalized for toxic epidermal necrolysis in a dermatologic intensive care unit. A questionnaire was sent to evaluate sequelae and their effects on sexual activity. Examination and surgical treatment were proposed to patients with symptomatic sequelae. Results: Twenty-eight of the 40 patients reported genital lesions during the acute phase of toxic epidermal necrolysis. No specific treatment was carried out during the acute period. Sequelae were observed in five cases, of which three involved the lower genital tract and two the vulva exclusively. The two patients with exclusive vulval involvement did not attempt any sexual activity. The other three patients with both vulval and vaginal lesions were unable to have normal sexual intercourse. Two of the three patients were treated surgically. One patient succeeded in having intercourse, but surgery failed to relieve dyspareunia. Conclusion: Genital involvement is frequent during toxic epidermal necrolysis but rarely leads to symptomatic sequelae. Surgery for synechiae is sometimes necessary to recover sexual activity because the vulvovaginal canal is stenotic. Because of the partial effect on pain relief after surgery, a preventive approach should be tried.