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Background
- Explosive dermatosis with tender erythema, bullae, and subsequent exfolliation
- Most commonly caused by medications
Clinical Features
Toxic epidermal necrolysis on legs
The back of a TENs patient on day 10, at the peak of the condition
- Malaise, anorexia, myalgias, arthralgias, fever, painful skin, GI symptoms
- Extracutaneous manifestations may persist for 1-2 weeks following skin symptoms
- Exam with warm tender erythema with overlying flaccid bullae, erosions with exfoliation
- Positive Nikolsky's sign (able to rub off superficial layers of skin with pressure)
- Mucosal involvement (oral, conjunctival, respiratory, GU)
- Systemic toxicity
- 25-35% Mortality
- Predictors of poor prognosis include: age, extent of disease, leukopenia, azotemia, and thrombocytopenia
Differential Diagnosis
Evaluation
- History of drug exposure
- Prodrome of malaise and fever
- Positive Nikolsky sign
- Oral, ocular, and/or genital mucositis with painful erosions
- Necrosis and sloughing of the epidermis
- Diagnosis is made my skin biopsy
- SJS vs TEN
- SJS - skin detachment of <10% of BSA
- TEN – skin detachment of >30% of BSA
Management
Disposition
- ICU
- Best cared for in a burn unit
- Immediate derm consult
References