Toxic epidermal necrolysis

Toxic epidermal necrolysis
  • Facts:
    Generally seen in adults
  • History / PE:
    Erythematous morbilliform eruption
    Exfoliation of skin
    Positive Nikolsky's sign (skin falls off with slightest touch/pressure)
  • Diagnosis:
    Biopsy shows full-thickness eosinophilic epidermal necrosis
    Greater than 30% body surface area involved
  • Treatment:
    Skin coverage
    Maintenance of fluids/electrolytes
  • Complications:
    Same as for burn victims
  • Associated With:
    Certain drugs (eg. sulfonamides, barbituates, phenytoin , NSAIDs )
    Erythema multiforme
  • Differential Diagnosis:
    1) Stevens Johnson syndrome (<10% of body covered)

    2) Staphylococcal scalded-skin syndrome (superficial damage, kids<6yo, infectious etiology)

    3) Graft-versus-host reaction
    4) Severe burn
    5) Toxic shock syndrome (associated with tampon and intravaginal device use)

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August 4th 2010