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What is Toxic Epidermal Necrolysis?

Toxic epidermal necrosis (TEN) is a rare and lethal immunological disorder, which occurs due to the administration of certain drugs or due to infections in which the skin starts peeling. It can affect individuals of all age groups, but older adults and individuals with weakened immunity are at a higher risk. Also, TEN is seen more commonly seen in women than men. Immediate medical attention is needed to manage this condition.

What are the main signs and symptoms?

The symptoms of TEN can be classified as

Early Symptoms

Late Symptoms

  • Purple or red rash on the body including the face
  • Swelling of the face and tongue
  • Blisters around the mouth, eyes, and vaginal area
  • Burnt appearance of the skin due to shedding

What are the main causes?

The drugs that are most commonly responsible for TEN are

  • Sulphonamides
  • Allopurinol
  • Non-steroidal anti-inflammatory drugs
  • Anti-epileptic drugs, such as phenytoin, lamotrigine, and carbamazepine

Other diseases, such as human immunodeficiency virus (HIV) and herpes simplex, may also lead to TEN.

How is it diagnosed and treated?

The physical examination of the individual is the first step in the diagnosis of TEN. To rule out the possibility of Stevens-Johnson syndrome (SJS), the percentage of body area exhibiting skin detachment is checked. If it is more than 30% of the body surface area, SJS is ruled out. A skin biopsy and histopathologic studies of the skin are performed to confirm the clinical diagnosis.

The immediate step in the management of the condition involves discontinuation of the recently prescribed medications. Other management measures include

  • Supportive care from experts
  • Non-sticky burn dressings to the affected area
  • Pain-relieving medications
  • Intravenous antibiotics to prevent infections
  • Intravenous immunoglobulins to stop the cytotoxic process
  • Topical emollient creams.
  1. Medicines for Toxic Epidermal Necrolysis

Medicines for Toxic Epidermal Necrolysis

Medicines listed below are available for Toxic Epidermal Necrolysis. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.

Medicine NamePack SizePrice (Rs.)
WysoloneWysolone 10 Tablet DT14
Low DexLow Dex Eye/Ear Drops8
DexacortDexacort Eye Drop13
Dexacort (Klar Sheen)Dexacort (Klar Sheen) 0.1% Eye Drop14
4 Quin Dx4 Quin Dx Eye Drop13
SolodexSolodex 0.1% Eye/Ear Drops4
Apdrops DmApdrops Dm 0.5% W/V/1% W/V Eye Drop103
Lupidexa CLupidexa C Eye Drop7
Dexcin MDexcin M Eye Drop59
Ocugate DxOcugate Dx Eye Drop8
Mfc DMfc D Eye Drop84
Mflotas DxMflotas Dx 0.5%W/V/0.1%W/V Eye Drop78
Mo 4 DxMo 4 Dx Eye Drop64
Moxifax DxMoxifax Dx Eye Drop52
Moxitak DmMoxitak Dm Eye Drops16
MyticomMyticom Eye Drop72
Occumox DmOccumox Dm 0.5%/0.1% Eye Drop0
Mflotas DMflotas D Eye Drop0
Mflotas TMflotas T Injection14
MilflodexMilflodex Eye Drop108
Milflox DmMilflox Dm Eye Drop18
Mosi DMosi D Eye Drop9

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References

  1. American Academy of Allergy, Asthma & Immunology. STEVENS-JOHNSON SYNDROME (TOXIC EPIDERMAL NECROLYSIS) DEFINITION. Milwaukee, WI [Internet]
  2. Wolfram Hoetzenecker et al. Toxic epidermal necrolysis. Version 1. F1000Res. 2016; 5: F1000 Faculty Rev-951. PMID: 27239294
  3. Alfonso Estrella-Alonso et al. Toxic epidermal necrolysis: a paradigm of critical illness. Rev Bras Ter Intensiva. 2017 Oct-Dec; 29(4): 499–508. PMID: 29340540
  4. National Institutes of Health; [Internet]. U.S. Department of Health & Human Services; Stevens-Johnson syndrome/toxic epidermal necrolysis.
  5. National Organization for Rare Disorders [Internet], Stevens-Johnson syndrome/toxic epidermal necrolysis
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