eMedicine Specialties > Infectious Diseases > Skin and Soft-Tissue Infections

Toxic Epidermal Necrolysis: Multimedia

Author: Victor Cohen, PharmD, Clinical Pharmacy Manager, Department of Emergency Medicine, Maimonides Medical Center, Assistant Professor, Division of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University
Coauthor(s): Samantha P Jellinek, PharmD, BCPS, Clinical Coordinator of Pharmacy Practice Residency Program, Manager of Medication Reconciliation and Safety, Maimonides Medical Center; Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Feb 12, 2009

Multimedia

Toxic epidermal necrolysis (TEN) ulcer in great t...Media file 1: Toxic epidermal necrolysis (TEN) ulcer in great toe (initial infection).
Toxic epidermal necrolysis (TEN) ulcer in great t...

Toxic epidermal necrolysis (TEN) ulcer in great toe (initial infection).

Hemorrhagic crusting of mucous membranes in toxic...Media file 2: Hemorrhagic crusting of mucous membranes in toxic epidermal necrolysis (TEN).
Hemorrhagic crusting of mucous membranes in toxic...

Hemorrhagic crusting of mucous membranes in toxic epidermal necrolysis (TEN).

Maculopapular rash in toxic epidermal necrolysis ...Media file 3: Maculopapular rash in toxic epidermal necrolysis (TEN).
Maculopapular rash in toxic epidermal necrolysis ...

Maculopapular rash in toxic epidermal necrolysis (TEN).

Diffuse maculopapular rash in toxic epidermal nec...Media file 4: Diffuse maculopapular rash in toxic epidermal necrolysis (TEN).
Diffuse maculopapular rash in toxic epidermal nec...

Diffuse maculopapular rash in toxic epidermal necrolysis (TEN).

Toxic epidermal necrolysis (TEN) blister on the i...Media file 5: Toxic epidermal necrolysis (TEN) blister on the index finger.
Toxic epidermal necrolysis (TEN) blister on the i...

Toxic epidermal necrolysis (TEN) blister on the index finger.

Epidermal sloughing in toxic epidermal necrolysis...Media file 6: Epidermal sloughing in toxic epidermal necrolysis (TEN).
Epidermal sloughing in toxic epidermal necrolysis...

Epidermal sloughing in toxic epidermal necrolysis (TEN).

More on Toxic Epidermal Necrolysis

Overview: Toxic Epidermal Necrolysis
Differential Diagnoses & Workup: Toxic Epidermal Necrolysis
Treatment & Medication: Toxic Epidermal Necrolysis
Follow-up: Toxic Epidermal Necrolysis
Multimedia: Toxic Epidermal Necrolysis
References

References

  1. Lyell A. Toxic epidermal necrolysis: an eruption resembling scalding of the skin. Br J Dermatol. Nov 1956;68(11):355-61. [Medline].

  2. Lang R, Walker J. An unusual bullous eruption. S Afr Med J. Feb 4 1956;30(5):97-8. [Medline].

  3. Debre R, Lemy M, Lamotte M. L'erythrodermie bulleuses avec epidermolyse. Bull Soc Pediatr (Paris). 1939;37:231-238.

  4. Lyell A. Toxic epidermal necrolysis (the scalded skin syndrome): a reappraisal. Br J Dermatol. Jan 1979;100(1):69-86. [Medline].

  5. Paul C, Wolkenstein P, Adle H. Apoptosis as a mechanism of keratinocyte death in toxic epidermal necrolysis. Br J Dermatol. Apr 1996;134(4):710-4. [Medline].

  6. Bastuji-Garin S, Fouchard N, Bertocchi M, et al. SCORTEN: a severity-of-illness score for toxic epidermal necrolysis. J Invest Dermatol. Aug 2000;115(2):149-53. [Medline].

  7. Moshfeghi M, Mandler HD. Ciprofloxacin-induced toxic epidermal necrolysis. Ann Pharmacother. Dec 1993;27(12):1467-9. [Medline].

  8. Ernst ME, Ernst EJ, Klepser ME. Levofloxacin and trovafloxacin: the next generation of fluoroquinolones?. Am J Health Syst Pharm. Nov 15 1997;54(22):2569-84. [Medline].

  9. Creamer JD, Whittaker SJ, Kerr-Muir M. Phenytoin-induced toxic epidermal necrolysis: a case report. Clin Exp Dermatol. Mar 1996;21(2):116-20. [Medline].

  10. Avakian R, Flowers FP, Araujo OE. Toxic epidermal necrolysis: a review. J Am Acad Dermatol. Jul 1991;25(1 Pt 1):69-79. [Medline].

  11. Fromowitz JS, Ramos-Caro FA, Flowers FP. Practical guidelines for the management of toxic epidermal necrolysis and Stevens-Johnson syndrome. Int J Dermatol. Oct 2007;46(10):1092-4. [Medline].

  12. Chaidemenos GC, Chrysomallis F, Sombolos K. Plasmapheresis in toxic epidermal necrolysis. Int J Dermatol. Mar 1997;36(3):218-21. [Medline].

  13. Picard E, Gillis D, Klapholz L. Toxic epidermal necrolysis associated with Klebsiella pneumoniae sepsis. Pediatr Dermatol. Dec 1994;11(4):331-4. [Medline].

  14. Barrera JE, Meyers AD, Hartford EC. Hypopharyngeal stenosis and dysphagia complicating toxic epidermal necrolysis. Arch Otolaryngol Head Neck Surg. Dec 1998;124(12):1375-6. [Medline].

  15. Power WJ, Ghoraishi M, Merayo-Lloves J. Analysis of the acute ophthalmic manifestations of the erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis disease spectrum. Ophthalmology. Nov 1995;102(11):1669-76. [Medline].

  16. Revuz J, Roujeau JC, Guillaume JC, Penso D, Touraine R. Treatment of toxic epidermal necrolysis. Créteil's experience. Arch Dermatol. Sep 1987;123(9):1156-8. [Medline].

  17. Becker DS. Toxic epidermal necrolysis. Lancet. May 9 1998;351(9113):1417-20. [Medline].

  18. Chave TA, Mortimer NJ, Sladden MJ, et al. Toxic epidermal necrolysis: current evidence, practical management and future directions. Br J Dermatol. Aug 2005;153(2):241-53. [Medline].

  19. Criton S, Devi K, Sridevi PK. Toxic epidermal necrolysis--a retrospective study. Int J Dermatol. Dec 1997;36(12):923-5. [Medline].

  20. Dmochowski M, Schwartz RA. Erythema multiforme, Steven-Johnson syndrome, and toxic epidermal necrolysis. In: Demis DJ, ed. Clinical Dermatology. Unit 7-3. 1999:1-20.

  21. Ghislain PD, Roujeau JC. Treatment of severe drug reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis and hypersensitivity syndrome. Dermatol Online J. Jun 2002;8(1):5. [Medline].

  22. Goulden V, Goodfield MJ. Recombinant granulocyte colony-stimulating factor in the management of toxic epidermal necrolysis. Br J Dermatol. Aug 1996;135(2):305-6. [Medline].

  23. Halevy S, Livni E. The role of macrophage migration inhibition factor in toxic epidermal necrolysis. Int J Dermatol. Oct 1997;36(10):776-8. [Medline].

  24. Horowitz SB, Stirling AL. Thalidomide-induced toxic epidermal necrolysis. Pharmacotherapy. Oct 1999;19(10):1177-80. [Medline].

  25. Hunger RE, Hunziker T, Buettiker U, Braathen LR, Yawalkar N. Rapid resolution of toxic epidermal necrolysis with anti-TNF-alpha treatment. J Allergy Clin Immunol. Oct 2005;116(4):923-4. [Medline].

  26. Imamura Y, Fujiwara S, Sato T. Successful treatment of toxic epidermal necrolysis with calcium sodium alginate fiber. Int J Dermatol. Nov 1996;35(11):834-5. [Medline].

  27. Lehrer-Bell KA, Kirsner RS, Tallman PG. Treatment of the cutaneous involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis with silver nitrate-impregnated dressings. Arch Dermatol. Jul 1998;134(7):877-9. [Medline].

  28. Letko E, Papaliodis DN, Papaliodis GN, et al. Stevens-Johnson syndrome and toxic epidermal necrolysis: a review of the literature. Ann Allergy Asthma Immunol. Apr 2005;94(4):419-36; quiz 436-8, 456. [Medline].

  29. Mukasa Y, Craven N. Management of toxic epidermal necrolysis and related syndromes. Postgrad Med J. Feb 2008;84(988):60-5. [Medline].

  30. Papadopoulos AJ, Schwartz RA, Fekete Z. Pseudoporphyria: an atypical variant resembling toxic epidermal necrolysis. J Cutan Med Surg. Nov-Dec 2001;5(6):479-85. [Medline].

  31. Paquet P, Piérard GE, Quatresooz P. Novel treatments for drug-induced toxic epidermal necrolysis (Lyell's syndrome). Int Arch Allergy Immunol. Mar 2005;136(3):205-16. [Medline].

  32. Pasricha JS, Khaitan BK, Shantharaman R. Toxic epidermal necrolysis. Int J Dermatol. Jul 1996;35(7):523-7. [Medline].

  33. Petersen KM. Erythema multiforme, Steven-Johnson syndrome, and toxic epidermal necrolysis. Pediatric Pharmacotherapy. 1998;4:[Full Text].

  34. Pharmacist's Letter. Trovan Warnings. Pharmacist Letter. 1998;[Full Text].

  35. Redondo P, Vicente J, Espana A. Photo-induced toxic epidermal necrolysis caused by clobazam. Br J Dermatol. Dec 1996;135(6):999-1002. [Medline].

  36. Roujeau JC, Kelly JP, Naldi L. Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. N Engl J Med. Dec 14 1995;333(24):1600-7. [Medline].

  37. Rzany B, Correia O, Kelly JP. Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis during first weeks of antiepileptic therapy: a case-control study. Study Group of the International Case Control Study on Severe Cutaneous Adverse Reactions. Lancet. Jun 26 1999;353(9171):2190-4. [Medline].

  38. Saghari S, Bakshandeh H, Kerdel F. Sudden onset of melanuria in a patient with metastatic melanoma and toxic epidermal necrolysis. Int J Dermatol. Feb 2002;41(2):116-8. [Medline].

  39. Salopek TG. Nikolsky's sign: is it 'dry' or is it 'wet'?. Br J Dermatol. May 1997;136(5):762-7. [Medline].

  40. Sanwo M, Nwadiuko R, Beall G. Use of intravenous immunoglobulin in the treatment of severe cutaneous drug reactions in patients with AIDS. J Allergy Clin Immunol. Dec 1996;98(6 Pt 1):1112-5. [Medline].

  41. Schwartz RA. Toxic epidermal necrolysis. Cutis. Mar 1997;59(3):123-8. [Medline].

  42. Schwartz RA, Dmochowski M. The erythema multiforme spectrum: pathogenesis, pathology and links with the pemphigus spectrum. Postepy Dermatol (Poznan). 1998;15:7-23.

  43. Sharma VK, Dhar S. Clinical pattern of cutaneous drug eruption among children and adolescents in north India. Pediatr Dermatol. Jun 1995;12(2):178-83. [Medline].

  44. Watanakunakorn P, Brodell RT. Toxic epidermal necrolysis. A widespread, life-threatening blistering reaction. Postgrad Med. Apr 2000;107(4):29-30. [Medline].

  45. White SI, Bowen-Jones D. Toxic epidermal necrolysis induced by terbinafine in a patient on long-term anti-epileptics. Br J Dermatol. Jan 1996;134(1):188-9. [Medline].

Further Reading

Keywords

toxic epidermal necrolysis, TEN, toxic epidermal necrosis, acute disseminated epidermal necrosis, acute skin failure, Lyell syndrome, Lyell’s syndrome, Stevens-Johnson syndrome, SJS-TEN

Contributor Information and Disclosures

Author

Victor Cohen, PharmD, Clinical Pharmacy Manager, Department of Emergency Medicine, Maimonides Medical Center, Assistant Professor, Division of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University
Victor Cohen, PharmD is a member of the following medical societies: American Association of Colleges of Pharmacy, American College of Clinical Pharmacy, American Society of Health-System Pharmacists, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Samantha P Jellinek, PharmD, BCPS, Clinical Coordinator of Pharmacy Practice Residency Program, Manager of Medication Reconciliation and Safety, Maimonides Medical Center
Samantha P Jellinek, PharmD, BCPS is a member of the following medical societies: American College of Clinical Pharmacy and American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Fred A Lopez, MD, Associate Professor and Vice Chair, Department of Medicine, Assistant Dean for Student Affairs, Louisiana State University School of Medicine
Fred A Lopez, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, Infectious Diseases Society of America, and Louisiana State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Charles V Sanders, MD, Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center
Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.