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.

Symptoms

Patient with toxic epidermal necrolysis presents with following signs and symptoms:

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.

Causes

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.

Complications

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

Diagnosis

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

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)

Toxic Epidermal Necrolysis, TEN