Toxic epidermal necrolysis: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
|||
| (4 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
{{Skin anatomy background images}} | |||
*Explosive dermatosis with tender erythema, bullae, and subsequent exfolliation | *Explosive dermatosis with tender erythema, bullae, and subsequent exfolliation | ||
*Most commonly caused by medications | *Most commonly caused by medications | ||
| Line 6: | Line 7: | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:Necrolysis epidermalis toxica 02.jpg|thumb|Toxic epidermal necrolysis on legs]] | |||
[[File:TENS patient on day 10.jpg|thumb|The back of a TENs patient on day 10, at the peak of the condition]] | |||
*Malaise, anorexia, [[myalgia]]s, [[arthralgia]]s, [[fever]], painful skin, GI symptoms | *Malaise, anorexia, [[myalgia]]s, [[arthralgia]]s, [[fever]], painful skin, GI symptoms | ||
*Extracutaneous manifestations may persist for 1-2 weeks following skin symptoms | *Extracutaneous manifestations may persist for 1-2 weeks following skin symptoms | ||
| Line 48: | Line 51: | ||
==References== | ==References== | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:Critical Care]] | [[Category:Critical Care]] | ||
Latest revision as of 18:17, 11 December 2024
Background
- Explosive dermatosis with tender erythema, bullae, and subsequent exfolliation
- Most commonly caused by medications
- Sulfa drugs, penicillins, anticonvulsants, and NSAIDs
- Other causes: infection, chemicals, malignancy, immunologic factors
Clinical Features
- 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
- Death is usually caused by infection, hypovolemia, and electrolyte disorders
- Predictors of poor prognosis include: age, extent of disease, leukopenia, azotemia, and thrombocytopenia
Differential Diagnosis
- Toxic infectious erythemas
- Exfoliative drug eruptions
- Primary blistering disorders
- Stevens-Johnsons syndrome
Erythematous rash
- Positive Nikolsky’s sign
- Febrile
- Staphylococcal scalded skin syndrome (children)
- Toxic epidermal necrolysis/SJS (adults)
- Afebrile
- Febrile
- Negative Nikolsky’s sign
- Febrile
- Afebrile
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
Management
- Monitor cardiopulmonary status closely
- Correct fluid and electrolyte imbalances
- Attend to infectious complications
Disposition
- ICU
- Best cared for in a burn unit
- Immediate derm consult