Toxic epidermal necrolysis: Difference between revisions
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==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 | ||
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==Clinical Features== | ==Clinical Features== | ||
*Malaise, anorexia, | [[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 | |||
*Extracutaneous manifestations may persist for 1-2 weeks following skin symptoms | *Extracutaneous manifestations may persist for 1-2 weeks following skin symptoms | ||
*Exam with warm tender erythema with overlying flaccid bullae, erosions with exfoliation | *Exam with warm tender erythema with overlying flaccid [[vesiculobullous rashes|bullae]], erosions with exfoliation | ||
*Positive | *Positive Nikolsky's sign (able to rub off superficial layers of skin with pressure) | ||
*Mucosal involvement (oral, conjunctival, respiratory, GU) | *Mucosal involvement (oral, conjunctival, respiratory, GU) | ||
*Systemic toxicity | *Systemic toxicity | ||
*25-35% Mortality | *25-35% Mortality | ||
**Death is usually caused by infection, hypovolemia, and electrolyte disorders | **Death is usually caused by [[infection]], [[hypovolemia]], and [[electrolyte disorders]] | ||
*Predictors of poor prognosis include: age, extent of disease, leukopenia, azotemia, and thrombocytopenia | *Predictors of poor prognosis include: age, extent of disease, [[leukopenia]], azotemia, and [[thrombocytopenia]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Toxic infectious erythemas | *Toxic infectious erythemas | ||
*Exfoliative drug eruptions | *Exfoliative [[drug eruptions]] | ||
*Primary blistering disorders | *Primary blistering disorders | ||
*[[Stevens-Johnsons syndrome]] | *[[Stevens-Johnsons syndrome]] | ||
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*SJS vs TEN | *SJS vs TEN | ||
**SJS - skin detachment of <10 | **SJS - skin detachment of <10% of [[BSA]] | ||
**TEN – skin detachment of >30 | **TEN – skin detachment of >30% of [[BSA]] | ||
==Management== | ==Management== | ||
*Monitor cardiopulmonary status closely | *Monitor cardiopulmonary status closely | ||
*Correct fluid and electrolyte imbalances | *Correct [[IVF|fluid]] and [[electrolyte imbalances]] | ||
*Attend to infectious complications | *Attend to infectious complications | ||
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==References== | ==References== | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[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