Toxic Epidermal Necrolysis, TEN

Toxic Epidermal Necrolysis, TEN

TEN is acronym to toxic epidermal necrolysis. It is an infrequent and life- threatening skin condition occur as a reaction to medication. It’s usually a intense form of Stevens-johnson syndrome. Usually TEN is diagnosed in the patients of SJS, when more than 30% of the surface of skin is affected.


Patient with toxic epidermal necrolysis presents with following signs and symptoms:TEN Symptoms Causes Treatment

  • Pain in the skin which would be widespread
  • Spreading rash. This rash will cover more than 30 % of the body
  • Large areas of peeling skin and blisters
  • On mucous membrane there would be sores, swelling and crusting. Mucous membrane of mouth, eyes and vagina is affected.

Usually TEN or SJS is a result of reaction of the skin to the medicine. Symptoms appear after 1 to 4 weeks of taking new drug. Most commonly drug which trigger SJS/TEN are antibiotics, epileptic drugs, sulfa drugs and allopurinol.

  • Sepsis
  • Lung involvement leading to acute respiratory failure
  • Visual impairment such as dry eyes, ingrown eyelashes
  • Permanent damage to the skin
  • Vaginal sores, which when untreated lead to vaginal fusion
  • Emotional distress

Toxic epidermal necrolysis is diagnosed in confirm cases of SJS. When SJS become severe and affect more than 30% of the body skin it is known as Toxic epidermal necrolysis (TEN).


Treatment options include:

  • Stopping the drug that causes the reaction on the skin
  • Major treatment are supportive care to make patient comfortable while skin scars are healing
  • Replacement of fluid and nutrition
  • Wound care by gently cleansing and applying bandage with infused Vaseline or other medication.
  • Pain control by giving analgesic mouth washes
  • Eye care provided by ophthalmologist
  • Breathing assistance
  • Medication can be given as one drug or in combination that gives effect on body such as cyclosporine or intravenous immunoglobulin (IVIG)
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