Toxic Epidermal Necrolysis (TEN)

Toxic epidermal necrolysis (TEN) is a severe skin condition, usually triggered by medications, that causes widespread skin cell death. It is considered a medical emergency and requires immediate attention.

Causes

TEN is most commonly caused by an adverse reaction to certain medications, including:

• Antibiotics such as sulfonamides and penicillins
• Anti-inflammatory medications like NSAIDs
• Anticonvulsants
• Allopurinol, used to treat gout

Symptoms

The symptoms of TEN can develop rapidly, often within days of starting a new medication. They may include:

• Fever
• Flu-like symptoms such as fatigue and muscle pain
• A rash that progresses to blisters and peels off, revealing tender skin underneath
• Mucous membranes (such as the eyes, mouth, and genital areas) may also be affected, leading to discomfort and difficulty with eating, drinking, or vision

Diagnosis

Diagnosing TEN involves a combination of clinical evaluation, medical history, and sometimes skin biopsies. The condition is often confused with other severe skin reactions like Stevens-Johnson Syndrome (SJS), but TEN tends to involve more body surface area and has a higher mortality rate.

Treatment

Treatment for TEN focuses on stopping the use of the offending medication, managing symptoms, and preventing infection. This may include:

• Supportive care in an intensive care unit or burn unit to manage fluid loss, electrolyte imbalance, and pain
• Wound care to promote healing and prevent infection
• Use of topical and systemic antibiotics to treat or prevent infections
• Patient isolation to minimize the risk of infection

Prognosis

The prognosis for TEN varies depending on several factors, including the extent of skin involvement, the patient's overall health, and how quickly treatment is initiated. Mortality rates can be high, especially in older adults or those with significant comorbidities.

Prevention

While not all cases of TEN can be prevented, being aware of the medications that can trigger this condition and monitoring for early signs of a skin reaction can help in early detection and treatment. Genetic testing may also identify individuals at higher risk of developing severe drug reactions.