Toxic Epidermal Necrolysis

What is toxic epidermal necrolysis?

Toxic epidermal necrolysis (TEN) is a life-threatening skin disorder that causes skin blistering and peeling. Flat skin sores (lesions) spread quickly and blend together. This leads to tissue death and skin peeling.

What causes toxic epidermal necrolysis?

This disorder is most often caused by a medicine reaction. These are often sulfa medicines, as well as other antibiotics or anticonvulsants. The very small number of TEN cases not caused by medicines are often from infections, vaccines, or graft-versus-host disease.

What are the symptoms of toxic epidermal necrolysis?

TEN causes the skin to peel in sheets. This leaves large, raw areas exposed. The loss of skin allows fluids and salts to ooze from the raw, damaged areas. These areas can easily become infected. Symptoms may be a bit different for each person. Symptoms may include:

• A painful, red area that spreads quickly

• The skin may peel without blistering

• Raw areas of skin

• Discomfort

• Fever

• Condition spreads to eyes, mouth, and throat, as well as genitals, urethra, and anus

The symptoms of TEN may look like other skin conditions. This is a life-threatening condition. It's important that you go to the emergency room right away for medical attention.

How is toxic epidermal necrolysis diagnosed?

Diagnosis is based on the appearance of the skin sores and the rapid development of symptoms. A skin biopsy is often done to examine a skin sample under the microscope to support the diagnosis.

How is toxic epidermal necrolysis treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how bad the condition is.

The disease progresses fast, often within 3 days. Treatment usually includes a hospital stay, often in the burn unit. If a medicine is causing the skin reaction, it is stopped. Treatment may include:

• Hospitalization

• Isolation to prevent infection

• Ointments and protective bandages

• IV (intravenous) fluid and electrolytes

• Antibiotics

• Intravenous immunoglobulin G

• Steroids

Key points about toxic epidermal necrolysis

• Toxic epidermal necrolysis is a life-threatening skin disorder that causes skin blistering and peeling.

• It causes the skin to peel in sheets. This leaves large, raw areas exposed. These areas can easily become infected.

• It's most often caused by a medicine reaction. The very small number of cases not caused by medicines are often due to infections, vaccinations, or graft-versus-host disease.

• It progresses fast, often within 3 days. Treatment usually includes hospitalization, often in the burn unit.

• Treatment may include isolation to prevent infection, ointments and protective bandages, IV fluids, antibiotics, and steroids.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours and on weekends and holidays.