Transcript Toxic Epidermal Necrolysis - UNM Biology Department Home Page

By Angela Cordova
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.
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
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.
SKIN STARTS SLOUGHING
SKIN COMPLETELY GONE
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.

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.
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 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
•
Life-threatening
sepsis.
• Severe infection
•
Keratoconjuctivitis
• Leads to impaired
vision and then
blindness

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.

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