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Toxic Epidermal Necrolysis

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By Angela Cordova. Toxic Epidermal Necrolysis. Introduction. TEN: Very rare and potentially fatal skin disorder. First described by Alan Lyell in 1956 as “an eruption resembling scalding of the skin”. Usually triggered by immunological reaction Similar symptoms to burn patients.

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introduction
Introduction

TEN:

  • Very rare and potentially fatal skin disorder.
  • First described by Alan Lyell in 1956 as “an eruption resembling scalding of the skin”.
  • Usually triggered by immunological reaction
  • Similar symptoms to burn patients.
causes of ten
Causes of TEN

Caused by immune reaction to:

  • Drugs taken for the first time (most commonly)
      • Antibiotics (penicillin), Anti-seizure agents, Butazones, and Sulfonamides
  • Certain types of infections
      • S. aureus, E.coli
  • Some vaccinations
      • Polio
  • Some viruses
symptoms
Symptoms

New substance in system leads to:

  • Onset of conjunctival burning, itching, tenderness, fever, cough, sore throat, headache, aches and pains
  • Followed by rapid onset of rash and blisters involving most of skin and mucous membranes.
      • Affects mouth, eyes, and, and genitalia more severely.
  • Large bullae develop and sheets of skin begin to slough off.
      • In severe cases there is danger to damage to larynx, bronchi, and esophagus from ulcerations.
  • Excruciating pain due to rash, blisters, and shedding of skin.
      • Includes eyelashes, fingernails, and toenails.
shedding skin
Shedding Skin

Skin starts sloughing

Skin completely gone

who does it affect
Who does it affect?

Affects:

  • People of all ages.
      • Many times older people due to the increasing amount of meds taken.
  • Both genders
      • Women more than men.
  • People with immuno-compromised systems.
      • HIV, AIDS, etc.
pathophysiology
Pathophysiology
  • It is believed that most patients have an abnormal metabolism of drug involved and it leads to a cell-mediated cytotoxic reaction.
  • Toxic drug metabolites accumulate in skin.
  • Attacks keratinocytes that express a foreign antigen.
  • Believe there is an over expression of tumor necrosis factor a-(TNF) in epidermis.
  • Leads to apoptosis of epidermis and stimulates cytotoxic T-lymphocytes.
  • Mimics a hypersensitivity reaction.
diagnosis
Diagnosis

Final diagnosis is done by:

  • Taking tissue samples from the nose, pharynx, and unruptured blisters of those suspected patients.
  • Samples are then cultured and organism responsible is identified.
mortality factors
Mortality factors
  • Mortality rates are between 10-70% for this condition.
  • Factors include:
        • Dehydration
        • The initiation of treatment
        • Aggressiveness of treatment
        • Level of care
        • Amount of surface area involved
        • Cancer/hematologic malignancy
complications
Complications
  • Life-threatening sepsis.
        • Severe infection
  • Keratoconjuctivitis
        • Leads to impaired vision and then blindness
treatment
Treatment
  • Treatment is similar to that of severe burns
      • All suspicious meds are discontinued immediately.
      • Maintain fluid and electrolyte balance to prevent dehydration.
      • Hydrotherapy to remove skin.
      • Protection of raw skin by topical agents.
      • Systemic antibiotic treatment with corticosteriods, used with extreme caution.
references
References
  • Cohen, Victor, Jellinek, Samantha, P., Toxic Epidermal Necrolysis, Medicine from web.MD, www.emedicine.com, May 2, 2007.
  • Smeltzer, Suzanne C., Bare, Brenda, Textbook 0f Medical Surgical Nursing, Lippincott Williams and Wilkins, 2004
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