Toxic epidermal necrolysis: Difference between revisions
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*Explosive dermatosis with tender erythema, bullae, and subsequent exfolliation | *Explosive dermatosis with tender erythema, bullae, and subsequent exfolliation | ||
*Most commonly caused by medications | *Most commonly caused by medications | ||
**Sulfa drugs, penicillins, anticonvulsants, and NSAIDs | **Sulfa drugs, [[penicillins]], [[anticonvulsants]], and [[NSAIDs]] | ||
**Other causes: infection, chemicals, malignancy, immunologic factors | **Other causes: infection, chemicals, malignancy, immunologic factors | ||
==Clinical Features== | ==Clinical Features== | ||
*Malaise, anorexia, myalgias, arthralgias, fever, painful skin, GI symptoms | *Malaise, anorexia, myalgias, arthralgias, [[fever]], painful skin, GI symptoms | ||
*Extracutaneous manifestations may persist for 1-2 weeks following skin symptoms | *Extracutaneous manifestations may persist for 1-2 weeks following skin symptoms | ||
*Exam with warm tender erythema with overlying flaccid bullae, erosions with exfoliation | *Exam with warm tender erythema with overlying flaccid bullae, erosions with exfoliation | ||
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*Exfoliative drug eruptions | *Exfoliative drug eruptions | ||
*Primary blistering disorders | *Primary blistering disorders | ||
*Kawasaki's disease | *[[Kawasaki's disease]] | ||
*Stevens-Johnsons syndrome | *[[Stevens-Johnsons syndrome]] | ||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 23:59, 14 July 2016
Background
- Explosive dermatosis with tender erythema, bullae, and subsequent exfolliation
- Most commonly caused by medications
- Sulfa drugs, penicillins, anticonvulsants, and NSAIDs
- Other causes: infection, chemicals, malignancy, immunologic factors
Clinical Features
- Malaise, anorexia, myalgias, arthralgias, fever, painful skin, GI symptoms
- Extracutaneous manifestations may persist for 1-2 weeks following skin symptoms
- Exam with warm tender erythema with overlying flaccid bullae, erosions with exfoliation
- Positive Nikolskly's sign (able to rub off superficial layers of skin with pressure)
- Mucosal involvement (oral, conjunctival, respiratory, GU)
- Systemic toxicity
- 25-35% Mortality
- Death is usually caused by infection, hypovolemia, and electrolyte disorders
- Predictors of poor prognosis include: age, extent of disease, leukopenia, azotemia, and thrombocytopenia
Differential Diagnosis
- Toxic infectious erythemas
- Exfoliative drug eruptions
- Primary blistering disorders
- Kawasaki's disease
- Stevens-Johnsons syndrome
Diagnosis
- History of drug exposure
- Prodrome of malaise and fever
- Positive Nikolsky sign
- Oral, ocular, and/or genital mucositis with painful erosions
- Necrosis and sloughing of the epidermis
- Diagnosis is made my skin biopsy
- SJS vs TEN
- SJS - skin detachment of <10 percent of BSA
- TEN – skin detachment of >30 percent of BSA
Management
- Monitor cardiopulmonary status closely
- Correct fluid and electrolyte imbalances
- Attend to infectious complications
Disposition
- ICU
- Best cared for in a burn unit
- Immediate derm consult
References
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