Toxic Epidermal Necrolysis (TEN) Questions & Answers

Updated: Jul 01, 2021
  • Author: Samantha P Jellinek-Cohen, PharmD, BCPS (AQ-ID); Chief Editor: Michael Stuart Bronze, MD  more...
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Questions & Answers

Overview

What is toxic epidermal necrolysis (TEN)?

What causes toxic epidermal necrolysis (TEN)?

What is the role of Stevens-Johnson syndrome (SJS) in the etiology of toxic epidermal necrolysis (TEN)?

How is toxic epidermal necrolysis (TEN) classified?

How is toxic epidermal necrolysis (TEN) with spots defined?

How is toxic epidermal necrolysis (TEN) without spots defined?

How is Overlap Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS-TEN) defined?

How is toxic epidermal necrolysis (TEN) diagnosed and treated?

How is toxic epidermal necrolysis (TEN) differentiated from staphylococcal scalded skin syndrome?

What should be included in patient education for toxic epidermal necrolysis (TEN)?

What is the pathophysiology of toxic epidermal necrolysis (TEN)?

How does toxic epidermal necrolysis (TEN) mimic a hypersensitivity reaction?

What causes widespread epidermolysis and blistering in toxic epidermal necrolysis (TEN)?

Which immunopathologic pathways are involved in the pathogenesis of toxic epidermal necrolysis (TEN)?

What causes toxic epidermal necrolysis (TEN)?

Which antibacterial drugs cause toxic epidermal necrolysis (TEN)?

Which anticonvulsants cause toxic epidermal necrolysis (TEN)?

Which NSAIDS cause toxic epidermal necrolysis (TEN)?

How does the risk of allopurinol-induced toxic epidermal necrolysis (TEN) vary over time?

Which lab tests are used to confirm specific drug etiologies for toxic epidermal necrolysis (TEN)?

What are non-pharmacological etiologies of toxic epidermal necrolysis (TEN)?

What is the incidence of toxic epidermal necrolysis (TEN) in the US?

What is the global incidence of toxic epidermal necrolysis (TEN)?

What are the racial predilections for toxic epidermal necrolysis (TEN)?

How does the prevalence of toxic epidermal necrolysis (TEN) vary by sex?

How does the incidence of toxic epidermal necrolysis (TEN) vary by age?

What is the mortality rate for toxic epidermal necrolysis (TEN)?

What are the most common causes of mortality in toxic epidermal necrolysis (TEN)?

What are the most important negative prognostic factors for toxic epidermal necrolysis (TEN)?

Which factors are associated with a poor prognosis of toxic epidermal necrolysis (TEN)?

How is the toxic epidermal necrolysis prognostic score (SCORTEN) calculated?

How is SCORTEN used to predict mortality in toxic epidermal necrolysis (TEN)?

Which organ systems are affected by toxic epidermal necrolysis (TEN)?

What are the cutaneous sequelae of toxic epidermal necrolysis (TEN)?

What are the ocular complications of toxic epidermal necrolysis (TEN)?

Presentation

What are the prodromal signs and symptoms of toxic epidermal necrolysis (TEN)?

How are the cutaneous eruptions characterized in toxic epidermal necrolysis (TEN)?

What are the manifestations of mucous membrane erosions in toxic epidermal necrolysis (TEN)?

What are the ocular manifestations in toxic epidermal necrolysis (TEN)?

What is the importance of a detailed medication history in the evaluation of toxic epidermal necrolysis (TEN)?

What are the most commonly implicated medications involved in toxic epidermal necrolysis (TEN)?

What are the vital signs findings suggestive of toxic epidermal necrolysis (TEN)?

Which skin exam findings are characteristic of toxic epidermal necrolysis (TEN)?

What is a positive Nikolsky sign in toxic epidermal necrolysis (TEN)?

What is the progression of erythema in patients with toxic epidermal necrolysis (TEN)?

What are the oral mucosa findings characteristic of toxic epidermal necrolysis (TEN)?

What are the ocular findings characteristic of toxic epidermal necrolysis (TEN)?

What are the respiratory findings characteristic of toxic epidermal necrolysis (TEN)?

What are the common causes of complications in toxic epidermal necrolysis (TEN)?

What causes septicemia and septic shock in toxic epidermal necrolysis (TEN)?

What may result from ulceration of mucosal membranes in toxic epidermal necrolysis (TEN)?

What are the possible ocular complications of toxic epidermal necrolysis (TEN)?

What are the pulmonary complications of toxic epidermal necrolysis (TEN)?

What are the GI complications of toxic epidermal necrolysis (TEN)?

DDX

What is the relationship of erythema multiforme major (EMM) to toxic epidermal necrolysis (TEN)?

How is erythema multiforme major (EMM) differentiated from toxic epidermal necrolysis (TEN)?

Which disorders must be histologically differentiated from toxic epidermal necrolysis (TEN)?

How are toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) differentiated?

Which conditions should be included in the differential diagnoses of toxic epidermal necrolysis (TEN)?

What are the differential diagnoses for Toxic Epidermal Necrolysis (TEN)?

Workup

How is toxic epidermal necrolysis (TEN) diagnosed?

How are necrotic keratinocytes characterized in toxic epidermal necrolysis (TEN)?

What is the role of lab tests in the workup of toxic epidermal necrolysis (TEN)?

What is the role of imaging studies in the workup of toxic epidermal necrolysis (TEN)?

Which blood studies are performed in the workup of toxic epidermal necrolysis (TEN)?

Which findings on blood studies suggest toxic epidermal necrolysis (TEN)?

Which findings of circulating immune complexes suggest toxic epidermal necrolysis (TEN)?

Which coagulation studies are performed in the workup of toxic epidermal necrolysis (TEN)?

How are fluids and electrolytes assessed in the workup of toxic epidermal necrolysis (TEN)?

What may cause significant fluid loss and electrolyte abnormalities in toxic epidermal necrolysis (TEN)?

What is the role of a skin biopsy in the workup of toxic epidermal necrolysis (TEN)?

Which histological findings are characteristic of toxic epidermal necrolysis (TEN)?

Treatment

What are the treatment options for toxic epidermal necrolysis (TEN)?

How does withdrawal of the inciting agent affect mortality in toxic epidermal necrolysis (TEN)?

What are the treatment guidelines for toxic epidermal necrolysis (TEN)?

What is included in prehospital care for toxic epidermal necrolysis (TEN)?

What is included in prehospital care of severe toxic epidermal necrolysis (TEN)?

What are the most important elements of emergency department (ED) treatment of toxic epidermal necrolysis (TEN)?

What should be the focus of emergency department (ED) care for toxic epidermal necrolysis (TEN)?

Which guidelines should be followed for fluid resuscitation in toxic epidermal necrolysis (TEN)?

What is the goal of resuscitation for toxic epidermal necrolysis (TEN) in the emergency department (ED)?

How is extensive skin involvement in toxic epidermal necrolysis (TEN) managed in the emergency department (ED)?

What are the benefits of anti-tumor necrosis factor–alpha (TNF-alpha) inhibitors in the treatment of toxic epidermal necrolysis (TEN)?

What is included in supportive systemic therapy for toxic epidermal necrolysis (TEN)?

How is bleeding managed in toxic epidermal necrolysis (TEN)?

How are ocular complication managed in toxic epidermal necrolysis (TEN)?

How is wound care provided in the treatment of toxic epidermal necrolysis (TEN)?

How is debridement of necrotic and desquamation areas performed in the treatment of toxic epidermal necrolysis (TEN)?

What is the role of antibiotics in the treatment of toxic epidermal necrolysis (TEN)?

What is the role of empiric antimicrobial therapy in the treatment of toxic epidermal necrolysis (TEN)?

How is pain managed in toxic epidermal necrolysis (TEN)?

What is the role of anticoagulant therapy in the treatment of toxic epidermal necrolysis (TEN)?

How are infections prevented in toxic epidermal necrolysis (TEN)?

Which treatments are effective for toxic epidermal necrolysis (TEN)?

What have studies shown regarding the benefits of using medications to treat toxic epidermal necrolysis (TEN)?

What are the risks of corticosteroids to treat toxic epidermal necrolysis (TEN)?

What is the role of plasmapheresis in the treatment of toxic epidermal necrolysis (TEN)?

What is the role of sucrose-depleted IV immune globulin (IVIg) in the treatment of toxic epidermal necrolysis (TEN)?

Which specialist consultations are required for the treatment of toxic epidermal necrolysis (TEN)?

Medications

What is the role of medication in the treatment of toxic epidermal necrolysis (TEN)?

Which medications in the drug class Corticosteroids are used in the treatment of Toxic Epidermal Necrolysis (TEN)?

Which medications in the drug class Topical Anesthetics are used in the treatment of Toxic Epidermal Necrolysis (TEN)?

Which medications in the drug class Antiseptics are used in the treatment of Toxic Epidermal Necrolysis (TEN)?

Which medications in the drug class Analgesics are used in the treatment of Toxic Epidermal Necrolysis (TEN)?

Which medications in the drug class Anticoagulants are used in the treatment of Toxic Epidermal Necrolysis (TEN)?

Which medications in the drug class Antihistamines are used in the treatment of Toxic Epidermal Necrolysis (TEN)?

Which medications in the drug class Antibiotics are used in the treatment of Toxic Epidermal Necrolysis (TEN)?

Which medications in the drug class Crystalloids are used in the treatment of Toxic Epidermal Necrolysis (TEN)?