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)